Introduction: Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair 
skull defects. The most common causes leading to calvarial skull defects include: depressed fractures 
of the skull, decompressive craniectomies (DC), tumor infiltration of calvarial bones, congenital 
deformities and inflammatory lesions.(1) Aim of the work: The aim of the work is to compare the 
outcome of two different manufacturing processes in reconstruction of calvarial skull defects using 
Titanium mesh versus Hydroxyapatite bone cement with assessment of cosmetic, functional 
outcome and incidence of complications in both study groups. Patients and Methods: Study 
participants: This is a prospective comparative study on first successive forty patients from 
December 2017 to December 2018 with calvarial skull defects of different etiologies, sites and sizes. 
Patients have been admitted and operated in neurosurgery department, Minia university hospital.
Results: This study included 40 patients with skull defects treated with cranioplasty. We divided 
patients into 2 groups, Group1: 20 patients were operated upon by cranioplasty using Titanium mesh 
and Group 2: 20 patients were operated upon by cranioplasty using HA bone cement implants.
Discussion: Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair skull 
defects. Optimal skull reconstruction is a challenge for neurosurgeons, and the strategy used to 
achieve the best result remains a topic of debate. Conclusions: Regarding cosmetic appearance, 
functional outcome and improvement of the clinical symptoms (syndrome of trephined), Cranioplasty 
using Titanium mesh and HA bone cement proved to have non-significant difference between both 
techniques in the reconstruction of calvarial skull defects despite their different etiologies.