Cranioplasty Timing After Decompressive Craniectomy: A Meta-Analysis of 4703 Patients.
Diana Ochoa Hernandez, Flor Belen Villalobos Villalobos, Ruth Yael Martínez Hernández et al.
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In 30 seconds
This systematic review and meta-analysis compared outcomes by cranioplasty timing after primary decompressive craniectomy. It included 38 studies and 4703 patients, defining early cranioplasty as ≤86 days and late as >86 days after craniectomy. Compared with late cranioplasty, early cranioplasty was associated with better scores on four functional measures, while overall complication rates were similar (risk ratio 1.08, 95% CI [0.83, 1.41], P = .55). Hydrocephalus was more frequent after early cranioplasty (risk ratio 1.58, 95% CI [1.07, 2.33], P = .02).
Key findings
- Early versus late cranioplasty was associated with higher Karnofsky performance scale scores (MD 15.50, 95% CI [0.80, 31.80], P < .0001).
- Early cranioplasty was associated with higher Barthel Index, functional independence measure, and activities of daily living scores than late cranioplasty.
- Overall complication rates did not differ significantly between early and late cranioplasty (risk ratio 1.08, 95% CI [0.83, 1.41], P = .55).
- Hydrocephalus was more common after early cranioplasty (risk ratio 1.58, 95% CI [1.07, 2.33], P = .02).
Why it matters
Timing decisions after decompressive craniectomy involve balancing functional recovery against procedure-related risks. This pooled analysis suggests early cranioplasty may be associated with better performance on several functional measures, but the higher observed hydrocephalus rate is relevant when weighing timing. The findings help frame this trade-off while highlighting uncertainty in the evidence.
What to keep in mind
The analysis pooled studies with heterogeneous designs and outcome measures; the authors call for standardized, multicenter prospective studies with consistent timing definitions.