Bilateral cranioplasty is a complex neurosurgical procedure performed to reconstruct or repair cranial defects involving both hemispheres of the skull. Indications include trauma, decompressive craniectomy, infection, tumor resection, or congenital anomalies. Recent advances in biomaterials and surgical planning have improved outcomes, yet bilateral cases remain challenging due to larger defect size, risk of complications, and the need for precise symmetry. This article reviews current techniques, materials, clinical outcomes, and complication management in bilateral cranioplasty.