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Early vs Delayed Cranioplasty on Neurological Outcomes in Syndrome of the Trephined: A Systematic Review
Ryan Enslow BS, Caroline Gillespie BS, Mia Panlilio BA, Abdulaziz Elemosho MD, Kerry-Ann Mitchell MD-PhD
The Ohio State University College of Medicine
2025-01-10
Presenter: Ryan Enslow
Affidavit:
We certify that the work submitted is original and wholly conducted by the authors listed in the submission.
Director Name: Kerry-Ann Mitchell
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND - Traumatic brain injury (TBI) and strokes lead to over 1 million hospitalizations annually in the US. Decompressive craniectomy (DC), a life-saving procedure wherein part of the skull is removed to relieve intracranial pressure, may result in Syndrome of the Trephined (SoT). SoT is characterized by neurological decline following DC that improves with cranioplasty. While cranioplasty restores cranial integrity and function, the optimal timing remains uncertain.
OBJECTIVE - This systematic review evaluates neurological outcomes in SoT patients undergoing early (<3 months) versus delayed (>3 months) cranioplasty.
METHODS - Using PRISMA guidelines, electronic searches of PubMed, Embase, Cochrane, Web of Science, and PsycINFO identified studies reporting outcomes in SoT patients based on cranioplasty timing.
RESULTS - Among 514 articles reviewed, 85 met inclusion criteria, with 201 patients undergoing early and 349 delayed cranioplasty. Hemorrhage was the primary cause of craniectomy in the early group (47.2%), while trauma predominated in the delayed group (59%). Symptoms most commonly experienced in the early group was altered consciousness (61.4%) and motor deficits in the delayed group (36.5%). Interestingly, overall improvement rates of these symptoms were significantly higher in the early group (97.9%) than the delayed group (75.0%, p<0.05).
CONCLUSION – Our findings show that early cranioplasty is associated with higher symptom improvement rates in SoT than delayed cranioplasty. The major limitation of this study is variability among the articles, with patients with TBI more likely to undergo delayed cranioplasty. Randomized controlled trials are needed to validate these findings and define optimal cranioplasty timing.
