Cranioplasty after decompressive craniectomy

Decompressive craniectomy is a well accepted procedure for management of refractory intracranial hypertension after head trauma. All cases of decompressive craniectomy eventually require second surgery for cranioplasty. Most people believe that cranioplasty is for cosmetic purpose only, where as it has a definitive impact on restoration of normal intracranial physiology and improvement of patient neurological condition. There is conflicting opinion regarding timing for cranioplasty even in text books. In this article we describe operative procedure adopted by us for cranioplasty and simultaneously review the literature regarding appropriate timing for cranioplasty after decompressive craniectomy. We found there are definitive advantages of early cranioplasty over delayed cranioplasty. Points in favor of early cranioplasty are highlighted.