Early Cranioplasty Benefits Patients with Obvious Bilateral Frontotemporal Bone Window Collapse After Decompressive Craniectomy.

Objective: Obvious skin flap collapse is often accompanied by reduced neurologic recovery after decompressive craniectomy. This study explored the feasibility of early cranioplasty (EC) in patients with obvious bilateral frontotemporal bone window (BFBW) collapse after decompressive craniectomy.

Methods: Patients with obvious BFBW collapse who underwent EC or traditional cranioplasty (TC) were divided into 3 groups according to their preoperative Glasgow Coma Scale (GCS) scores. The indexes, including postoperative incision healing, salivation symptoms, postoperative infection, and 6-month postoperative follow-up after EC or TC, were compared in each group.

Results: Two of 32 patients with GCS scores of 3 to 8 points experienced poor healing of the scalp incision after EC, whereas no TC patients had poor healing. Incision healing significantly differed between these 2 groups (P > 0.05), and long-term prognoses based on GOS scores were the same after a 6-month postoperative follow-up (P > 0.05). In patients with GCS scores of 9 to 12 points, salivation improved by 84.2% and 17.6% in the EC and TC groups, respectively (P < 0.05) after a mean follow-up time of 6 months. Similarly, positive neurologic recovery rates (GOS score 4-5 points) were higher in the EC group (88.9%) than in the TC group (60.0%) (P < 0.05) and did not differ between the EC (79.3%) and TC (80.6%) groups in patients with GCS scores of 13 to 15 points (P > 0.05). However, salivation improved by 86.7% in the EC group but by only 12.5% in the TC group (P < 0.05).

Conclusion: We therefore recommend EC for patients with obvious BFBW collapse and GCS scores ≥9.