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

• Early CP can reduce the duration of operation.
• Early CP cannot reduce the overall complications.
• Early CP even increases the risk of hydrocephalus.

BackgroundCranioplasty 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.ObjectiveTo 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.MethodsIn 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.ResultsNine 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].ConclusionEarly 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.