Early vs late cranioplasty: what is better?
OBJECTIVE
Cranioplasty is the surgical repair of skull defects, which commonly is performed after traumatic skull injuries due to tumor removal or decompressive craniectomy. Several studies reported improvement in cognitive functions following cranioplasty in patients with severe brain damage. The reasons why exist such clinical improvement is not completely understood, although the increase in cerebrospinal fluid hydrodynamics with the potential improvement of local and global cerebral hemodynamics, blood flow, and metabolism may play a pivotal role. We investigated whether the cranioplasty improved neurological recovery and the whole array of cognitive functions or just some specific domains.


METHODS
A total of 30 consecutive brain-injured subjects with craniectomy were enrolled and underwent a structured neuropsychological assessment immediately before the cranioplasty, 1 month after the cranioplasty and 1 year after the surgical procedure.


RESULTS
Our results showed that cranioplasty may facilitate the cognitive recovery, independently from the surgical timing. Particularly, we observed an important cognitive recovery in the period immediately after cranioplasty, while the improvement trend settles after a lapse of time, and the recovery starts to slow down.


CONCLUSIONS
Cranioplasty seems to significantly improve neuropsychological and motor status in the patients with skull defects, independently from cranioplasty timing and patient's clinical status.
a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.
Francesco
F
Corallo
a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.
Maria Cristina
MC
De Cola
a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.
Viviana
V
Lo Buono
a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.
Angela
A
Marra
a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.
Rosaria
R
De Luca
a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.
Antonia
A
Trinchera
a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.
Placido
P
Bramanti
a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.
Rocco Salvatore
RS
Calabrò
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000503:physiopathology / Q000601:surgery*; D003071:Cognition / Q000502:physiology; D056424:Decompressive Craniectomy / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000639:trends*; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome
cranioplasty; neuropsychological improvement; rehabilitation; severe brain injury; surgical timing