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Updated: Feb 19, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
How Early Can We Perform Cranioplasty for Traumatic Brain injury After Decompressive Craniectomy? A Retrospective
Na Rae Yang1, Jihye Song2, Kyeong-Wook Yoon3
1Department of Neurosurgery, Ewha Womans University Medical Center, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Insights
Performing early cranioplasty (CP) around 34 days after decompressive craniectomy (DC) for traumatic brain injury (TBI) may reduce complications like ventriculomegaly and improve patient outcomes.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Neurology
Background:
- Decompressive craniectomy (DC) treats intracranial hypertension after severe traumatic brain injury (TBI).
- Cranioplasty (CP) follows DC, but optimal timing remains unclear.
- This study investigates the earliest safe timing for CP.
Purpose of the Study:
- Determine the earliest feasible time point for cranioplasty (CP) after decompressive craniectomy (DC) in patients with traumatic brain injury (TBI).
- Evaluate the impact of early versus late CP timing on patient complications and outcomes.
Main Methods:
- Retrospective review of CT scans from 159 TBI patients undergoing CP after DC.
- Determined earliest CP timing based on intracranial pressure resolution in serial CT scans.
- Compared complication rates and 6-month Glasgow Outcome Scale (GOS) scores between early and late CP groups.
Main Results:
- Earliest CP timing identified as approximately 34 days post-DC.
- No significant difference in overall complications between early and late CP groups.
- Ventriculomegaly occurred significantly more often in the late CP group (P=0.026).
- Early CP was a predictor of a good outcome.
Conclusions:
- Cranioplasty (CP) can be safely performed around 34 days after decompressive craniectomy (DC) for TBI.
- Early CP is associated with reduced incidence of ventriculomegaly.
- Patients undergoing early CP demonstrated better 6-month Glasgow Outcome Scale scores.
Objective:
Decompressive craniectomy (DC) is used to treat intractable intracranial hypertension after severe traumatic brain injury (TBI). Cranioplasty (CP) is typically performed weeks or months later. However, the optimal timing for CP is unknown. We aimed to determine the earliest possible time point for CP.
Methods:
We retrospectively reviewed brain computed tomography images from 159 patients who underwent CP after DC for TBI at 3 hospitals. We determined the earliest possible day for CP by reviewing the resolution of intracranial pressure in serial brain computed tomography images between DC and CP. The early CP group was defined as the group within the earliest possible timing of CP; other cases constituted the late CP group. We compared complications and the Glasgow Outcome Scale scores at 6 months between groups.
Results:
The mean initial Glasgow Coma Scale score was 8.33 ± 3.46. The time interval between DC and CP was 94.75 ± 143.98 days. The earliest possible timing for CP was determined to be 34.60 ± 34.36 days after DC. The incidence of complications did not differ significantly between groups, except for ventriculomegaly, which occurred more frequently in the late CP group (P = 0.026). Predictors of good outcome were revision because of infection, preoperative epidural hematoma, early cranioplasty, and no ventriculomegaly after DC.
Conclusions:
CP can be performed at around 34 days after DC for TBI. Ventriculomegaly occurred less frequently and the 6-month Glasgow Outcome Scale score was better in the early CP group than in the late CP group.
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