Cranioplasty: Does Timing Have Any Effect on the Degree of Neurological Recovery or the Complication Rate?

Decompressive craniectomy is commonly performed to relieve elevated intracranial pressure caused by trauma, stroke, hemorrhage, or edema [1–9]. Cranioplasty is often subsequently performed to restore cranial cosmesis, provide cerebral protection, and facilitate neurological rehabilitation [10, 11]. Cranioplasty itself has been shown to provide neurological improvement and the question of how long to wait before cranioplasty has received considerable attention [12–18]. Most surgeons wait for recovery from the initial indication for decompressive craniectomy with resolution of edema and inflammation, but often these patients can be lost to follow up for months to years [19]. Recent studies indicate that earlier cranioplasty may improve neurologic recovery and avoid certain complications [12, 15, 18, 19]. This chapter will use findings from two published meta-analyses on the association between the timing of cranioplasty on neurological improvement and complication rate to evaluate the current level of evidence and provide clinical and research recommendations [12, 18].