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

Decompressive craniectomy (DC) is a surgical procedure that involves the removal of a portion of the skull and is used to treat various conditions. However, this creates a significant defect in the skull that requires subsequent reconstruction through a procedure called cranioplasty. Cranioplasty aims to improve cerebral blood flow and enhance neurological functions. The timing of cranioplasty is still a topic of debate and can generally be classified into two categories: "early cranioplasty" and "delayed cranioplasty." To provide evidence-based recommendations for the optimal timing of cranioplasty, our meta-analysis compares the safety and efficacy of early and delayed cranioplasty.

An electronic search was conducted on PubMed, Embase, and Cochrane. Multiple reviewers independently screened the studies using Rayyan software, and any conflicts were resolved through mutual discussion. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). Statistical analysis was carried out using Review Manager version 5.41, with I² statistics applied to evaluate heterogeneity.

Early cranioplasty was associated with increased risk of overall complications 1.43 (95% CI: 0.81 to 2.53; p = 0.22) and postoperative infections 1.36 (95% CI: 0.36 to 5.11; p = 0.65), shorter operative time -26.76 (95% CI: -41.20 to -12.32; p = 0.0003), and a reduced intraoperative blood loss -21.53 (95% CI: -38.30 to -4.77; p = 0.01). The neurological outcomes, that is, MMSE and GOS scores, favored the delayed cranioplasty or showed no significant difference, respectively.

The meta-analysis produced mixed results and required a prospective, multicenter, randomized controlled trial with specified outcome measures to establish a balance between surgical safety and functional recovery.