Optimal Timing of Cranioplasty After Craniectomy: A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis compared functional outcomes and complications across cranioplasty timing windows after craniectomy. It included 55 studies involving 8602 patients. Compared with delayed cranioplasty, early cranioplasty was associated with better scores on several functional measures; ultra-early cranioplasty showed the greatest benefit in absolute Barthel Index scores and lower bone flap resorption risk. Complication rates did not differ significantly across timing groups. The authors conclude that reconstruction within 100 days may be associated with improved recovery, while noting that nonrandomized timing comparisons cannot establish causality.

Key findings

• Early cranioplasty was associated with better Barthel Index absolute and gain scores, and higher absolute functional independence measure and modified motor assessment and enhancement scale scores than delayed cranioplasty.
• Ultra-early cranioplasty showed the greatest benefit in absolute Barthel Index scores and significantly reduced bone flap resorption risk.
• Overall complication rates did not differ significantly across timing groups; infection, hydrocephalus, and hematoma rates also did not vary meaningfully.
• Implant material and traumatic etiology did not significantly affect the reported outcomes.

Why it matters

Cranioplasty timing may be relevant to functional recovery as well as bone flap resorption, while the review found no meaningful increase in complications with earlier timing. These findings help frame the balance between reconstruction timing and outcomes, but the evidence is associative: clinical stability and treatment selection may influence when patients undergo surgery.

What to keep in mind

Timing was not randomized, and clinical stability or treatment selection may have influenced group assignment; the findings therefore do not establish that earlier cranioplasty causes better outcomes.