The other day, I saw another patient who had a failed cranial repair with exposed titanium mesh at an outside hospital and was in a very uncomfortable mood. Cranial repair is considered a minor surgery in neurosurgery, so why are there so many cases of failed repair? The failure of this surgery means that the patient has to undergo two more surgeries: one to take the repair material and one to repair the skull again, causing a lot of damage to the patient both financially and physically! So I feel compelled to say a few words here. The skull repair materials nowadays are basically made of titanium mesh, and they can be reconstructed and shaped by computer to the extent that they basically match the patient’s skull defect, and the cosmetic effect and post-operative response are worlds apart from the original silicone rubber and bone cement. However, with such a good material, there are still many cranial repair surgeries that fail, and some people even trim the computer shaped titanium mesh intraoperatively! I once had a fellow ask me intraoperatively how to trim the shaped titanium mesh. I was surprised because the shaped titanium mesh does not need to be trimmed, and if it needs to be trimmed, there is a problem with the surgeon’s knowledge of the shaped titanium mesh and surgical technique. Because the skull repair with shaped titanium mesh must separate the temporalis muscle to completely expose the edge of the defective skull, if you do not master the skills, you often do not dare to separate the temporalis muscle and still perform the surgery according to the original method of silicone rubber material repair, then you have to trim the titanium mesh. This affects the cosmetic appearance after surgery, and there may also be pain when the temporalis muscle is cut by the titanium mesh when chewing. My purpose of writing this article is to hope that some neurosurgeons will pay attention to basic surgical skills, improve their knowledge of cranial repair surgery with shaped titanium mesh, stop performing surgery with new materials with old ideas, and actually improve the technique of separating myocutaneous flaps. I also hope that patients with cranial defects will have less pain and torment and get better treatment.