Decompressive craniectomy (DC) followed by Cranioplasty (CP) has become most common life saving surgery
in neurosurgical practice. Till to date timing of CP is a matter of debate. Early surgery is associated with
complications due to resolving hematoma and persistent brain edema. Delayed surgery has complications like
sinking skin flap syndrome due to exposure of cranial defect to atmospheric pressure. Autologous bone flaps
remain the most commonly used compared to synthetic materials for CP, but the mode of preservation is usually
on surgeon’s preference due to limited studies on which mode is superior. Recent studies suggested that fixation
of bone flaps by titanium microplates and screws had less bone resorption and better fusion rates.
Aim: To compare efficacy and outcomes of early (<3months) versus late (>3 months) CP, subcutaneous versus
cryopreservation of bone flap and titanium microplates and screws versus prolene fixation of bone flap
Materials and Methods: A total number of 56 cases who underwent CP with various indications between
September 2018 to July 2021 in our institute were included. The decision of procedure was made according to
patient and surgeon discretion. All the cases were operated under General Anaesthesia.
Results: A total of 56 patients were included, 44 males (78.57%) and 12 females (21.43%), 40 (71.42%) were early
and 16 (28.58%) were late Cranioplasties. Storage of bone flap was subcutaneous in 40 (71.42%) patients and
was cryopreserved in 16 (28.58%). Bone flap was fixed with Mini plates and screws in 44 (78.57%) patients and
with prolene in 12 (21.43%) patients. Fusion rates of bone flap was relatively higher in patients who underwent
Early CP (95%) than in Late CP (75%) and in patients where bone flap was fixed with titanium microplates and
screws (95%) than in patients where prolene was used for fixation (67%), with no significant difference depending
on where bone flap was preserved, subcutaneously (90%) or by cryopreservation (88%).
Conclusion: Early and late cranioplasties had significant difference in outcomes with early CP having better
fusion rates, lesser duration of surgery and hospital stay. Fixation of bone flap with titanium microplates and
screws had better outcomes compared to prolene fixation. Subcutaneous and cryopreservation bone flap storages
had similar outcomes, with subcutaneous preservation requiring additional surgery. Our study concluded that
early CP with cryopreservation and titanium microplates and screws fixation of bone flap had better outcomes
with better fusion rates, less morbidity and better cosmetic appearance.