Cranioplasty after supratentorial decompressive craniectomy. When is the optimal timing

The purpose of this study was to evaluate the outcome and complication rates of different cranioplastic procedures. This study retrospectively reviewed 242 consecutive patients who underwent cranioplasty. The indications for craniectomy, the timing and materials employed for the cranial repair procedures were analysed in all patients as well as their early and long-term results. The immediate patient's outcome after cranioplasty was assessed by reviewing medical records and the late outcome was evaluated with a telephone questionnaire. The patients were divided into three groups depending on the timing of cranioplasty [ultra early group (until 6 weeks), early group (7-12 weeks) and delayed group (after 13 weeks following craniectomy)]. The ultra early cranioplasty in the form of reimplantation of the patient's own skull flap led to a rapid improvement of the patient's neurological function and late outcome. The analysis of the registered postoperative complications revealed that there were no significant differences between the groups examined. This study found that ultra early cranioplasty by reimplanting the patient's own previously removed and frozen skull bone was a safe and successful strategy.