Early Cranioplasty is Associated with Greater Neurological Improvement: A Systematic Review and Meta-Analysis

Abstract

Cranioplasty may improve neurological function, and earlier cranioplasty may enhance this effect. Future prospective studies evaluating long-term, comprehensive neurological outcomes will be required to establish the true effect of cranioplasty on neurological outcome.

Complications in cranioplasty after decompressive craniectomy: timing of the intervention

“…Malcolm et al recently reported that early CP is associated with greater neurological improvement, and therefore advocate early CP [7]. Although CP is not a complex surgical procedure, high complication rates up to 37% have been published, without an encompassing theory as to causes or risk factors [8].…”

Timing for cranioplasty to improve neurological outcome: A systematic review

“…Although we contacted eight authors for further information regarding missing data (Bender et al, ; Di Stefano et al, ; Honeybul et al, ; Jasey, Ward, Lequerica, & Chiaravalloti, ; Shahid, Mohanty, Singla, Mittal, & Gupta, ; Songara, Gupta, Jain, Rege, & Masand, ; Stelling, Graham, & Mitchell, ; Su et al, ), only four of them were able to provide original individual data useful for our meta‐analysis (Di Stefano et al, ; Honeybul et al, ; Jasey et al, ; Songara et al, ). At the end of selection, six articles and two systematic reviews (Malcolm et al, ; Xu et al, ) have been included in the present study.…”

“…Rish et al () reported that cranioplasty performed within 6 months after DC is associated with poor outcomes, Huang et al () sustained that the timing of cranioplasty is not related to the neurological outcomes of TBI, and Corallo et al found that the neurological recovery is independent from timing and patient's clinical status. (Shamay‐Tsoory, Tomer, Goldsher, Berger, & Aharon‐Peretz, ) However, Malcom et al, in a more recent meta‐analysis, including three motor outcomes and a tool specific for postcoma patients, confirmed the positive effect of cranioplasty on neurological function and claimed that an early procedure may enhance this effect (Malcolm et al, ). Similarly, many recent studies recommend early cranioplasty because of its association with clinical improvement (Bender et al, ; Chibbaro et al, ; Liang et al, ; Quah et al, ), which can be performed as early as 2 weeks postcraniectomy (and in any case not later than 6 months) to lower the overall cost of care by eliminating the need for additional hospital admissions (Beauchamp et al, ).…”

“…Several studies define "early cranioplasty" as a cranioplasty performed within 91 days from decompressive craniectomy (Malcolm et al, 2018(Malcolm et al, , 2016Xu et al, 2015). Notably, Xu et al (2015) sustain that early cranioplasty may reduce the duration of surgery by reducing difficulties in dissecting the scalp flap and fitting the bone flap.…”

“…In the last few years, researcher interest is moving toward the association of cranioplasty with the recovery of consciousness and cognitive function as well as the timing of performing cranioplasty (Huang et al, 2013;Shahid et al, 2018;Songara et al, 2016). Rish et al (1979) reported that cranioplasty performed within 6 months after DC is associated with poor outcomes, Huang et al (2013) (Malcolm et al, 2018). Similarly, many recent studies recommend early cranioplasty because of its association with clinical improvement (Bender et al, 2013;Chibbaro et al, 2011;Liang et al, 2007;Quah et al, 2016), which can be performed as early as 2 weeks postcraniectomy (and in any case not later than 6 months) to lower the overall cost of care by eliminating the need for additional hospital admissions (Beauchamp et al, 2010).…”