en Basic Neurosurgery Case Series <span class="fontstyle0"><strong>Background and Importance</strong>: </span><span class="fontstyle2">Decompressive craniectomy is an emergency neurosurgical procedure to reduce intracranial hypertension. Cranioplasty is an elective neurosurgical procedure to reconstruct the skull defect due to decompressive craniectomy. This study aims to review two different types of cranioplasty and comparecomputer-designed patientspecific titanium implant cranioplasty against titanium mesh with polymethyl methacrylate (PMMA) cranioplasty, regardingtheir complications and outcomes after the procedure.</span><br> <span class="fontstyle0"><strong>Case Presentation:</strong> </span><span class="fontstyle2">This is a retrospective analysis of 150 patients who had undergone cranioplasty in PSG Institute of Medical Sciences and Research, Coimbatore, India from January 2014 to January 2023. A total of 46 patients underwent cranioplasty with a computerdesigned, patient-specific titanium implant, and 104 patients underwent cranioplasty with a titanium mesh and PMMA implant. The parameters compared between the two procedures included the timing of surgery, cosmetic satisfaction, duration of hospital stay, wound infection, wound gaping, implant exposure, and necessity of implant removal.</span><br> <span class="fontstyle0"><strong>Conclusion:</strong> </span><span class="fontstyle2">Even though both procedures protect brain parenchyma from injuries due to direct trauma, patient-specific implant cranioplasty yielded shorter operating time, less wound infection, smaller wound gaping, reduced implant exposure, and better cosmetic appearance when compared with titanium mesh with PMMA implant cranioplasty.</span> Decompressive craniectomy, Cranioplasty, Titanium, PMMA, Infection 0 0 http://irjns.org/browse.php?a_code=A-10-474-3&slc_lang=en&sid=1 P.R Rajkumar 100319475328460012551 100319475328460012551 No Department of Neurosurgery, PSG Institute of Medical Sciences and Research, Coimbatore, India. Thirumurthy Subramanian 100319475328460012552 100319475328460012552 No Department of Neurosurgery, PSG Institute of Medical Sciences and Research, Coimbatore, India. Jayaprakash Duraisamy jayaprakashduraisamy@yahoo.com 100319475328460012553 100319475328460012553 Yes Department of Neurosurgery, PSG Institute of Medical Sciences and Research, Coimbatore, India. Aniketh Shankar Komarraju 100319475328460012554 0009-0005-8430-9703 No Department of Neurosurgery, PSG Institute of Medical Sciences and Research, Coimbatore, India.