Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review

Background: Cranioplasty is considered as a routine procedure in everyday neurosurgical practice for the patient with cranial defect, however, there is no established consensus on optimal surgical timing.

Objective: To compare the effect of early cranioplasty (1-3 months after DC) and late cranioplasty (3-6 months after DC) on the complications and recovery of neurological function in the management of patients who received decompressive craniotomy.

Methods: In this paper, the authors report a systematic review and meta-analysis of operative time, complications and neurological function outcomes on different timing of cranioplasty. Randomized or non-randomized controlled trials of early cranioplasty and late cranioplasty surgery were considered for inclusion.

Results: Nine published reports of eligible studies involving 1209 participants meet the inclusion criteria. Compared with late cranioplasty, early cranioplasty had no significant difference in overall complications [RR=1.14, 95%CI (0.83, 1.55), p>0.05], infection rates [RR=0.87, 95%CI (0.47, 1.61), p>0.05], intracranial hematoma [RR=1.09, 95%CI (0.53, 2.25), p>0.05]; subdural fluid collection [RR=0.47, 95%CI (0.15, 1.41), p>0.05]. However, early CP significantly reduced the duration of cranioplasty [mean difference=-13.46, 95%CI (-21.26, 5.67), p<0.05]. The postoperative hydrocephalus rates were significant higher in the early cranioplasty group [RR=2.67, 95%CI (1.24, 5.73), p<0.05].

Conclusion: Early CP can only reduce the duration of operation, but cannot reduce the complications of patients and even increase the risk of hydrocephalus. More evidence from advanced multi-center studies is needed to provide illumination for the timing selection of CP surgery.