Effects of Early Cranioplasty on the Restoration of Cognitive and Functional Impairments

Abstract

Objective: To delineate the effect of early cranioplasty on the recovery of cognitive and functional impairments in patients who received decompressive craniectomy after traumatic brain injury or spontaneous cerebral hemorrhage.

Methods: Twenty-four patients who had received cranioplasty were selected and divided according to the period from decompressive craniectomy to cranioplasty into early (≤90 days) and late (>90 days) groups. The Korean version of the Mini-Mental State Examination (K-MMSE), Korean version of the Modified Barthel Index (K-MBI), and Functional Independence Measure (FIM) were evaluated at admission just after decompressive craniectomy and during the follow-up period after cranioplasty.

Results: Twelve patients were included in the early group, and another 13 patients were included in the late group. The age, gender, type of lesion, and initial K-MMSE, K-MBI, and FIM did not significantly differ between two groups. However, the total gain scores of the K-MMSE and FIM in the early group (4.50±7.49 and 9.42±15.96, respectively) increased more than those in the late group (-1.08±3.65 and -0.17±17.86, respectively), and some of K-MMSE subscores (orientation and language) and FIM subcategories (self-care and transfer-locomotion) in the early group increased significantly when compared to those in the late group without any serious complications. We also found that the time to perform a cranioplasty was weakly, negatively correlated with the K-MMSE gain score (r=-0.560).

Conclusion: Early cranioplasty might be helpful in restoring cognitive and functional impairments, especially orientation, language ability, self-care ability, and mobility in patients with traumatic brain injury or spontaneous cerebral hemorrhage.

Keywords: Cognition; Decompressive craniectomy; Recovery of function; Stroke; Traumatic brain injuries.