Objective:

To evaluate the optimal timing of cranioplasty (CP) post-decompressive craniectomy (DC) in traumatic brain injury (TBI) patients, comparing early cranioplasty (EC) and late cranioplasty (LC) regarding postoperative complications and functional outcomes, specifically assessing the rates of complications and the degree of functional recovery.

Key Findings:

• EC may reduce operative time and extra-axial fluid collections compared to LC, but evidence on overall complications remains inconsistent.
• EC is associated with greater postoperative neurological recovery, though it may increase the risk of hydrocephalus.
• Recent studies show no consistent superiority of EC over LC regarding long-term functional outcomes.

Interpretation:

While EC may offer certain functional and technical advantages, it could also lead to increased complication risks, highlighting the need for careful patient selection. The optimal timing for CP remains unclear, necessitating further research to inform clinical practice.

Limitations:

• Heterogeneous definitions of early and delayed CP leading to potential misclassification bias.
• Reliance on retrospective studies with small sample sizes and inadequate adjustment for confounding variables.
• Limited exploration of effect modifiers such as implant material and CSF shunt insertion.
• Potential publication bias affecting the reliability of the findings.

Conclusion:

The study aims to inform evidence-based recommendations for CP timing and material combinations, emphasizing the need for further investigation into the safety and efficacy of different approaches, and the establishment of standardized definitions for EC and LC.