The grafts used to perform cranioplasty were made of titanium modelled by CAD/CAM technology and produced by electron beam melting (EBM) technology. CAD/CAM EBM is a novel technique for titanium powder sintering that provides the precise shape of the titanium implant in a virtual 3D model of the patient’s skull (obtained from DICOM (Digital Imaging and Communications in Medicine) CT-imaging). The technique uses a high-energy focused electron beam that melts the titanium powder in a vacuum chamber. This beam not only models a simple plate but also precisely shapes the CAD model of the prosthesis in three dimensions. A high-resolution CT scan of the entire skull is performed on every patient before the surgical procedure (Fig. 1a–c). The acquired images in DICOM format are transferred to the manufacturing company (Fig. 2a). An accurate 3D virtual image of the skull is created, via software, for each patient and the titanium plate is then precisely shaped on this, respecting the symmetry and individual bone curvature (Fig. 2b, c). The 3D virtual images of the titanium graft and skull are digitally verified with the prior CT scan, and then a 3D plastic prototype of the patient’s skull defect is printed (Fig. 2d). With the EBM technique, the previously designed titanium graft is printed by the sintering of titanium powder and then fitted on the 3D plastic prototype of the skull defect to ensure the best clinical and esthetic results before surgical implantation (Fig. 2d, e). The custom-made EBM titanium grafts are provided with holes for drainage and textured surfaces to improve their integration with soft tissue. Moreover, the graft’s thin and definitely shaped margins precisely follow the bone defect margins. The fixation is performed with titanium screws directly onto the bone circumference. A postoperative CT scan is performed to evaluate the surgical result (Fig. 1d–f).