IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy.
Brain Behav. 2018 Nov;8(11):e01106. doi: 10.1002/brb3.1106. Epub 2018 Oct 2.
Cranioplasty is a surgical technique applied for the reconstruction of the skullcap removed during decompressive craniectomy (DC). Cranioplasty improves rehabilitation from a motor and cognitive perspective. However, it may increase the possibility of postoperative complications, such as seizures and infections. Timing of cranioplasty is therefore crucial even though literature is controversial. In this study, we compared motor and cognitive effects of early cranioplasty after DC and assess the optimal timing to perform it.
A literature research was conducted in PubMed, Web of Science, and Cochrane Library databases. We selected studies including at least one of the following test: Mini-Mental State Examination, Rey Auditory Verbal Learning Test immediate and 30-min delayed recall, Digit Span Test, Glasgow Coma Scale, Glasgow Outcome Scale, Coma Recovery Scale-Revised, Level of Cognitive Functioning Scale, Functional Independence Measure, and Barthel Index.
Six articles and two systematic reviews were included in the present study. Analysis of changes in pre- and postcranioplasty scores showed that an early procedure (within 90 days from decompressive craniectomy) is more effective in improving motor functions (standardized mean difference [SMD] = 0.51 [0.05; 0.97], p-value = 0.03), whereas an early procedure did not significantly improve neither MMSE score (SMD = 0.06 [-0.49; 0.61], p-value = 0.83) nor memory functions (SMD = -0.63 [-0.97; -0.28], p-value < 0.001). No statistical significance emerged when we compared studies according to the timing from DC.
It is believed that cranioplasty performed from 3 to 6 months after DC may significantly improve both motor and cognitive recovery.
颅骨修复术是一种用于重建减压性颅骨切除术（DC）中切除的颅骨的手术技术。颅骨修复术从运动和认知角度改善康复效果。然而，它可能会增加术后并发症的可能性，如癫痫发作和感染。因此，颅骨修复术的时机至关重要，尽管文献存在争议。在这项研究中，我们比较了 DC 后早期颅骨修复术对运动和认知的影响，并评估了进行颅骨修复术的最佳时机。
在 PubMed、Web of Science 和 Cochrane Library 数据库中进行了文献检索。我们选择了至少包含以下测试之一的研究：简易精神状态检查、 Rey 听觉言语学习测试即时和 30 分钟延迟回忆、数字跨度测试、格拉斯哥昏迷量表、格拉斯哥结局量表、昏迷恢复量表修订版、认知功能水平量表、功能独立性量表和巴氏量表。
本研究纳入了 6 篇文章和 2 篇系统评价。分析颅骨修复术前、后评分的变化表明，早期手术（减压性颅骨切除术后 90 天内）在改善运动功能方面更有效（标准化均数差 [SMD] = 0.51 [0.05；0.97]，p 值 = 0.03），而早期手术对 MMSE 评分（SMD = 0.06 [-0.49；0.61]，p 值 = 0.83）和记忆功能（SMD = -0.63 [-0.97；-0.28]，p 值 < 0.001）的改善没有显著影响。当我们根据与 DC 的时间间隔比较研究时，没有出现统计学意义。
据信，在 DC 后 3 至 6 个月进行颅骨修复术可能会显著改善运动和认知恢复。
