• Aref Nassar, Joy Naba, and Joe Demian.
• Plastic surgery department, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon. Electronic address: arefnassar@hotmail.com.
• World Neurosurg. 2025 Jan 22; 194: 123628123628.

BackgroundBurr holes can lead to cranial defects that result in cosmetic and functional issues. Effective reconstruction of these burr holes is crucial for improving patient outcomes, yet there is no consensus on the optimal techniques and materials. This systematic review critically evaluates the efficacy and safety of various materials used in neurosurgical practice for burr hole reconstruction.MethodsA comprehensive literature search was performed across PubMed, Medline (via Ovid), Embase, and the Cochrane Library, targeting studies published from January 2000 onwards. The quality of the included studies was systematically assessed, and data pertaining to the types of reconstruction materials, clinical outcomes, and complication rates was extracted.ResultsSeventeen studies met the inclusion criteria. The materials employed in burr hole reconstruction were categorized into biological and synthetic groups. Biological materials, such as autologous bone grafts and bone dust, demonstrated varying degrees of integration and resorption, with cortical bone grafts showing superior results. Synthetic materials were assessed for their safety, complication profiles, and esthetic outcomes. Titanium covers were associated with the lowest rates of skin depression. However, the overall quality of evidence was constrained by the heterogeneity in study designs, the brief follow-up periods, and a reliance on subjective outcome measures.ConclusionsBurr hole reconstruction is essential for enhancing esthetic outcomes and patient satisfaction post-trephination. Autologous bone grafts, particularly cortical grafts, demonstrate superior integration, while synthetic materials offer viable alternatives with low complication rates. Future research should focus on long-term outcomes and the implementation of standardized, objective evaluation methods.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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