Background: Cranioplasty is a well established neurosurgical procedure for reconstructing cranial defects and is indicated for cerebral protection, cosmetic restoration and reversing the altered cerebral physiology. Cranioplasty had been evolved over several decades with progressive advancement regarding the surgical technique and the implant materials used to restore the of calvarial continuity either autograft or allograft .

Objective: To assess the outcome of cranioplasty with different materials in pediatric patients.
Patients and Methods: A total of fifty consecutive cranioplasties in 46 patients were studied. The sex, age, reason for skull defect, type of implant used, number of cranioplasties done per patient, cosmetic result, wound healing, complications and management of complications were recorded. The mean follow-up interval was 14 months (range from 8 –25months).
Results: There was no mortality from the cranioplasty procedure. Six (30%) out of 20 patients with autologus graft cranioplasty developed complications in the form of subcutaneous surgical emphysema at the donor site of rib graft in two cases, and four cases develpoed graft resorption underwent reoperation using titanium mesh. Two (6.6%) out of 30 cases of synthetic graft cranioplasty developed complications, in the form of infection in acrylic cranioplasty resolved with antibiotic.
Conclusion: Autologous bone graft has higher incidence of spontanous resorption in pediatric patients. Synthetic material can be used safely in cranioplasty for patients above 5 years. Acrylic cranioplasty is safe and effective method in centers with limited facilities.