Background: Some authors have hypothesized that cranioplasty after decompressive craniectomy (DC) could positively influence functional recovery through several mechanisms. However, only a few studies with small sample sizes have investigated the effects of cranioplasty on functional recovery. Our study aims at evaluating the role of post-DC cranioplasty in influencing the functional recovery in a large cohort of patients with different etiologies of acquired brain injury (ABI).
Methods: This retrospective study consecutively enrolled 253 patients with ABI, consisting of 108 adults who underwent post-DC cranioplasty and 145 adults who did not. All the subjects underwent a 6-month individual rehabilitation program. Demographic data, etiology, classification and anatomical site of brain injury, neurological and functional assessment at baseline and on discharge, and number of deaths during hospitalization were recorded.
Results: In our cohort, 145 patients (57.3%) and 108 patients (42.7%) had, respectively, a hemorrhagic stroke (HS) and a traumatic brain injury (TBI). Only in the patients with TBI cranioplasty emerged as an independent predictor of better functional outcome in terms of the Functional Independence Measure (FIM) total score at discharge (β = 0.217, p = 0.001) and of the FIM variation during rehabilitation (ΔFIM) (β = 0.315, p = 0.001). Conversely, in the case of HS, no associations were found between post-DC cranioplasty and functional recovery.
Conclusions: Post-DC cranioplasty was associated with better functional recovery six months after TBI but not in the patients with HS. Although the pathophysiological mechanisms underlying HS are different from those of TBI and possibly play a role in the different outcomes between the two groups, further studies are needed to investigate the mechanisms underlying the observed differences.
Keywords: cranioplasty; hemorrhagic stroke; outcome; rehabilitation; traumatic brain injury.