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 p 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.