Comparison of Complications in Early and Late Cranioplasty Following Decompressive Craniectomy Due to Traumatic Brain...

Objectives: This study investigates the relationship between the time elapsed from decompressive craniectomy to cranioplasty and surgical complications in patients after traumatic brain injury. Methods: PubMed, Scopus, and Web of Science were systematically searched for references using the PRISMA guidelines. The data were subjected to the first phase of screening, which required the studies to be published between 1990 and 2024, be written in English, and include patients who underwent cranioplasty following decompressive craniectomy due to traumatic brain injury. The second phase of screening assessed whether the studies included at least 10 patients and compared their outcomes based on the time between decompressive craniectomy and cranioplasty. A subgroup analysis was performed for ultra-early cranioplasty patients. Results: This meta-analysis included fifteen studies involving patients who underwent early (n = 666) and late cranioplasty (n = 1214) after decompressive craniectomy. All studies had a retrospective observational design. There was no statistically significant difference in the odds of complications between the groups, although late cranioplasty had slightly elevated odds of developing hydrocephalus (OR 1.66, 95% CI 0.55-4.99, p = 0.36). Interesting results stemmed from a subgroup analysis of the ultra-early cohort; they included favoring the ultra-early group in the odds of overall complications (OR 0.46, 95% CI 0.08-2.56, p = 0.38) and hygroma (OR 0.45, 95% CI 0.15-1.37, p = 0.16). Later cranioplasty had better outcomes in the category of seizure (OR 1.56, 95% CI 0.75-3.28, p = 0.24). Conclusions: Cranioplasty within 90 days, considered early, had no statistically significant differences in complication rates compared to late cranioplasty.