Cranioplasty, the repair of a skull vault defect by insertion of an object (bone or nonbiological materials such as metal or plastic plates), is a well-known procedure in modern neurosurgery. Brain protection and cosmetic aspects are the major indications of cranioplasty. Aim of Study: This study is to compare the cosmetic outcome and complications rate after cranioplasty in patients with firearm injuries, coming from war in Yemen to our neurosurgery center in Egypt, with cranial bony defects.

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... atients and Methods: Patients were selected with the following inclusion criteria: 1-Size of defect: Patients with bony defects more than 3cm. 2-Location of the defect: Frontal, parietal and occipital defects, (temporal defects are covered with muscle and usually doesn't need repair). We reviewed 23 patients retrospectively, underwent cranioplasty between March 2017 and November 2018. Titanium mesh (TM; 17 patients) and poly methyl methylacrylate (bone cement) reconstructed grafts (BC; 6 patients) were used as implants. Results: More than 95% of cases (22 patients) presented to us with history of primary wound debridement, bullet extraction (in some cases) and wound closure in Yemen before coming to our center in Egypt. Before surgery, 18.8% (4 patients) presented with pseudomeningiocele formation, 2 patients presented with CSF leaking skin fistula. Intra-operatively, 82.6% (19 patients) of them didn't undergo any kind of duroplasty. Regardless of implanted materials, more than 82.6% (19 patients) of the CP patients were satisfied with the cosmetic outcome. No statistically significant difference was observed among the two groups. The TM group showed lower complication rates compared with BC group, while the BC group demonstrated a higher post-CP subgaleal collection rate (33.3%, 2 patients) than the TM group (5.8%, 1 patient). However, no significant difference in the incidence of post-CP infection was observed among the two groups. Conclusion: In comparison with TM and BC, cranioplasty with TM shows benefits in terms of lower post-CP complication, less intraoperative bleeding loss, shorter operation time and in-hospital stay.