title: Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review.
abstract: BACKGROUND
  Cranioplasty is considered as a routine procedure in everyday neurosurgical practice for the patient with cranial defect, however, there is no established consensus on optimal surgical timing.
  
  
  OBJECTIVE
  To compare the effect of early cranioplasty (1-3 months after DC) and late cranioplasty (3-6 months after DC) on the complications and recovery of neurological function in the management of patients who received decompressive craniotomy.
  
  
  METHODS
  In this paper, the authors report a systematic review and meta-analysis of operative time, complications and neurological function outcomes on different timing of cranioplasty. Randomized or non-randomized controlled trials of early cranioplasty and late cranioplasty surgery were considered for inclusion.
  
  
  RESULTS
  Nine published reports of eligible studies involving 1209 participants meet the inclusion criteria. Compared with late cranioplasty, early cranioplasty had no significant difference in overall complications [RR=1.14, 95%CI (0.83, 1.55), p>0.05], infection rates [RR=0.87, 95%CI (0.47, 1.61), p>0.05], intracranial hematoma [RR=1.09, 95%CI (0.53, 2.25), p>0.05]; subdural fluid collection [RR=0.47, 95%CI (0.15, 1.41), p>0.05]. However, early CP significantly reduced the duration of cranioplasty [mean difference=-13.46, 95%CI (-21.26, 5.67), p<0.05]. The postoperative hydrocephalus rates were significant higher in the early cranioplasty group [RR=2.67, 95%CI (1.24, 5.73), p<0.05].
  
  
  CONCLUSIONS
  Early CP can only reduce the duration of operation, but cannot reduce the complications of patients and even increase the risk of hydrocephalus. More evidence from advanced multi-center studies is needed to provide illumination for the timing selection of CP surgery.
authors.affiliation: Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, PR China. Electronic address: tony_xuhao@163.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, PR China.
authors.forename: Chaoshi
authors.initials: C
authors.lastname: Niu
authors.affiliation: Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, PR China.
authors.forename: Xianming
authors.initials: X
authors.lastname: Fu
authors.affiliation: Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, PR China.
authors.forename: Wanhai
authors.initials: W
authors.lastname: Ding
authors.affiliation: Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, PR China.
authors.forename: Shiying
authors.initials: S
authors.lastname: Ling
authors.affiliation: Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, PR China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, PR China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Ji
mesh_terms: D056424:Decompressive Craniectomy / Q000379:methods; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012886:Skull / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cranioplasty; Decompressive craniotomy; Meta-analysis; Systematic review