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Early Cranioplasty Improved Rehabilitation in Patients With Traumatic Skull Injuries

Cong, Zhongxiao BM; Shao, Xianhao BM; Zhang, Lei PhD; Zhao, Duanyun MD; Zhou, Xudong PhD; Yi, Chiling PhD; Shao, Yi MD

doi: 10.1097/WNQ.0000000000000133
Original Articles

Background: Increasing literature data suggest that cranioplasty at early stage of skull defects may lead to better rehabilitation outcome. This study was conducted to explore the relationship between the timing of cranioplasty and neurological rehabilitation in patients with traumatic skull injury (TSI).

Methods: A total of 77 patients were admitted as a result of TSI, assessed on rehabilitation measures, and grouped by the intervals between skull injury and cranioplasty. All patients underwent cranioplasty between 20 and 500 days after TSI. Neurological function and general wellbeing of the patients before and after cranioplasty were assessed as per National Institute of Health Stroke Score (NIHSS) and Karnofsky Performance Status (KPS) scales, respectively.

Results: Cranioplasty led to significant improvement in functioning, with all the patients demonstrating clinically meaningful gains. There were approximately 80%, 50%, and 20% reduction in postcranioplasty NIHSS in patients who underwent cranioplasty within 90 days (group 1, P<0.01), 90 to 180 days (group 2, P<0.05), and beyond 180 days (group 3, P<0.05) after TSI, respectively. The postcranioplasty KPS scores significantly improved in all the patients compared with those before cranioplasty (P<0.05). The KPS improvement rate was significantly higher in group 1 compared with those in groups 2 and 3 (P<0.05), with no difference between groups 2 and 3. A reciprocal relationship between the intervals from TSI to cranioplasty and the KPS improvement rate was observed.

Conclusions: Cranioplasty improved neurological rehabilitation and general wellbeing in patients with TSI, with the optimal surgical time no more than 90 days after skull injuries.

*Operating Room

§Department of Neurosurgery, Qilu Hospital

School of Medicine, Shandong University, Jinan, P.R. China

Cell and Tissues Therapies Unit, Biological Science Section, Office of Scientific Evaluation, Therapeutic Goods Administration, Australia

Z.C., X.S., and L.Z contributed equally.

The authors declare no conflict of interest.

Reprints: Yi Shao, MD, Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong, P.R. China (e-mail:

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.