title: The impact of cranioplasty on neurological function.
abstract: OBJECTIVE
  To assess changes in neurological function after cranioplasty.
  
  
  METHODS
  Functional and neurocognitive assessments including activities of daily living assessment, functional independence measure (FIM) and the Cognitive assessment report (COGNISTAT) were conducted on all patients within 72 h before and 7 days after cranioplasty. A change in the total FIM score of 2 points was taken to be clinically significant.
  
  
  RESULTS
  Assessments were performed on 25 patients. The functional status was unchanged in eighteen patients (72%), four patients (16%) demonstrated a significant improvement and three patients (12%) deteriorated significantly. Those with deterioration after cranioplasty had some forms of complications including pneumocephalus or seizure. After excluding the three patients who had immediate medical or surgical complications after surgery, there was a mild overall improvement in the mean FIM score (2.1, 95% confidence interval 0.1-4.3, p = 0.049), mainly due to an improvement in their motor function.
  
  
  CONCLUSIONS
  A small but significant number of patients appear to improve clinically following cranioplasty. The so-called syndrome of the trephined may be more common than had been previously appreciated.
authors.affiliation: Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia. stephen.honeybul@health.wa.gov.au
authors.forename: Stephen
authors.initials: S
authors.lastname: Honeybul
authors.forename: Courtney
authors.initials: C
authors.lastname: Janzen
authors.forename: Kate
authors.initials: K
authors.lastname: Kruger
authors.forename: Kwok M
authors.initials: KM
authors.lastname: Ho
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001927:Brain Diseases / Q000503:physiopathology / Q000601:surgery*; D001930:Brain Injuries / Q000503:physiopathology / Q000601:surgery; D003072:Cognition Disorders / Q000209:etiology* / Q000503:physiopathology; D056424:Decompressive Craniectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D012886:Skull / Q000601:surgery*; D020521:Stroke / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed