Abstract
IntroductionCranioplasty is a surgical technique applied for the reconstruction of the skullcap removed during decompressive craniectomy (DC). Cranioplasty improves rehabilitation from a motor and cognitive perspective. However, it may increase the possibility of postoperative complications, such as seizures and infections. Timing of cranioplasty is therefore crucial even though literature is controversial. In this study, we compared motor and cognitive effects of early cranioplasty after DC and assess the optimal timing to perform it.MethodsA literature research was conducted in PubMed, Web of Science, and Cochrane Library databases. We selected studies including at least one of the following test: Mini‐Mental State Examination, Rey Auditory Verbal Learning Test immediate and 30‐min delayed recall, Digit Span Test, Glasgow Coma Scale, Glasgow Outcome Scale, Coma Recovery Scale‐Revised, Level of Cognitive Functioning Scale, Functional Independence Measure, and Barthel Index.ResultsSix articles and two systematic reviews were included in the present study. Analysis of changes in pre‐ and postcranioplasty scores showed that an early procedure (within 90 days from decompressive craniectomy) is more effective in improving motor functions (standardized mean difference [SMD] = 0.51 [0.05; 0.97], p‐value = 0.03), whereas an early procedure did not significantly improve neither MMSE score (SMD = 0.06 [−0.49; 0.61], p‐value = 0.83) nor memory functions (SMD = −0.63 [−0.97; −0.28], p‐value < 0.001). No statistical significance emerged when we compared studies according to the timing from DC.ConclusionsIt is believed that cranioplasty performed from 3 to 6 months after DC may significantly improve both motor and cognitive recovery.
Highlights
Cranioplasty is a surgical technique applied for the reconstruction of the skullcap removed during decompressive craniectomy (DC)
Decompressive craniectomy (DC), consisting in the partial removal of the skullcap, is widely used in the management of neurological emergencies as it allows a decrease in brain swelling and intractable intracranial hypertension (Hofmeijer et al, 2009)
We considered patients with disorders of consciousness separately, including studies reporting data from the Glasgow Coma Scale (GCS; Doyle, 1989), the Glasgow Outcome Scale (GOS; Wilson, Pettigrew, & Teasdale, 1998), the Coma Recovery Scale‐Revised (CRS‐R; Giacino, Kalmar, & Whyte, 2004), and the Level of Cognitive Functioning Scale (LCF; Sander, 2012)
Summary
Decompressive craniectomy (DC), consisting in the partial removal of the skullcap, is widely used in the management of neurological emergencies as it allows a decrease in brain swelling and intractable intracranial hypertension (Hofmeijer et al, 2009). Promising results following this procedure in both motor and cognitive outcomes have been reported. This link between the repair of the cranial defect and the changes in cerebrovascu‐ lar and cerebrospinal fluid hydrodynamics seems to have positive effects on neurological functions (Bijlenga, Zumofen, Yilmaz, & Creisson, 2007). An early intervention (i.e., within 3 months) seems to reduce neurological complications, especially in patients with severe acquired brain injury, since a lesion in the postacute period might be negative for motor and cognitive recovery (Huang, Lee, Yang, & Liao, 2013). We want to review current literature on motor and cognitive effects of an early cranioplasty after decompressive cra‐ niectomy, focusing on the optimal timing to perform it
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