Cranioplasty timing and its effect on the functional neurological outcome in traumatic brain injury

Abstract

The best time to do cranioplasty (CP) and how it will affect the neurological outcome is still in debate. Moreover, being one of the most commonly performed interventions in neurosurgery, its complication rate is among the highest in literature. The aim of this study is to assess the effect of timing of cranioplasty (CP) on the functional neurological outcome and post-operative complications in patients of traumatic brain injury. A retrospective cohort study was conducted in patients who underwent CP between 2018 and 2022. Early and late cranioplasties were defined as surgeries performed within and more than 90 days of decompressive craniectomy, respectively. The Glasgow Outcome Score- Extended (GOSE) and Functional Independence Measure (FIM) were used to assess the neurological outcome. Late CP cohort patients presented with subdural hygroma (SDG), which had a significant correlation. In post-CP complications, SSI, post-CP hydrocephalus and new onset seizures had a significant correlation with late CP (p <0.001).  In early CP GOS E score of 6 was seen, whereas a better score of 7 was seen late cohort. In FIM rating, both had maximum number of cases in Minimal Assistance group. The neurological outcome in patients who underwent early versus late CP is almost identical. We drew the conclusion that early CP often resulted in less post-operative morbidity. A lower number of early CP cohort subjects experienced post-CP HCP, seizures, and SSI.  In order to reduce postoperative problems in TBI cases receiving DC, we advise an early CP based on the study's findings.