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Early Versus Delayed Cranioplasty After Decompressive Craniectomy: A Systematic Review and Meta-Analysis.

Muhammad Taha1, Yasir Saleem1, Muhammad Waqar Shahid1

  • 1Khyber Medical College, Peshawar, Pakistan.

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|March 10, 2026
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Summary

This meta-analysis compared early versus delayed cranioplasty after decompressive craniectomy. Results were mixed, suggesting further research is needed to balance surgical safety and functional recovery for optimal patient outcomes.

Keywords:
cranioplastydecompressive craniectomymeta‐analysistiming

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Area of Science:

  • Neurosurgery
  • Surgical Outcomes
  • Evidence-Based Medicine

Background:

  • Decompressive craniectomy (DC) creates a skull defect requiring cranioplasty for improved cerebral blood flow and neurological function.
  • The optimal timing for cranioplasty, whether early or delayed, remains a subject of debate in clinical practice.

Purpose of the Study:

  • To compare the safety and efficacy of early versus delayed cranioplasty.
  • To provide evidence-based recommendations for the optimal timing of cranioplasty.

Main Methods:

  • A systematic meta-analysis was conducted using data from PubMed, Embase, and Cochrane databases.
  • Studies were independently screened and assessed for quality using the Newcastle-Ottawa Scale (NOS).
  • Statistical analysis was performed using Review Manager version 5.41, with heterogeneity evaluated using I² statistics.

Main Results:

  • Early cranioplasty showed a trend towards increased overall complications and postoperative infections, but had shorter operative times and reduced intraoperative blood loss.
  • Neurological outcomes, measured by MMSE and GOS scores, favored delayed cranioplasty or showed no significant difference.

Conclusions:

  • The meta-analysis yielded inconclusive results regarding the optimal timing for cranioplasty.
  • A prospective, multicenter, randomized controlled trial is necessary to establish optimal timing, balancing surgical safety and functional recovery.