The associated benefits of a cranioplasty on rehabilitation: a review of the literature

Abstract

Background: There is an ever-increasing demand for appropriate neurorehabilitation to optimise recovery post-traumatic brain injury. Some patients undergo decompressive surgery, which involves partial removal of the skull bone to help relieve the associated swelling and oedema. These patients are left with a skull defect and are placed on a waiting list for surgical repair of same by means of a procedure referred to as a cranioplasty. Cranioplasty, until recently, was not regarded as being a clinical priority in the neurorehabilitation phase, given the limited evidence supporting enhanced recovery. Aims: To highlight the phenomenon syndrome of the trephined and to establish the potential impact it has on enhanced neurorehabilitation and recovery. Methods: The paper is a narrative literature review of the associated effects of a cranioplasty on rehabilitation published in peer-reviewed journals between 2013 and 2019. Papers were identified via a search of PubMed, Medline and CINAHL electronic databases. Findings: The associated symptoms of syndrome of the trephined are predominately motor and cognitive in nature and are believed to result in a stalling or regression of the recovery process until the skull defect is repaired. The writer has critically analysed studies that have compared motor and cognitive functioning pre- and post-cranioplasty. Patients with enhanced functioning in the cognitive domain displayed marked improvements in the areas of memory, language and executive functioning. With regards to motor function, improvements were most evident in areas of activities of daily living, eating, grooming, walking and toileting. The theory underlying these improvements appears to be physiological in nature. Conclusions: Contrary to former opinion, the findings of this literature review highlight the importance of repairing skull breech prior to rehabilitation to optimise patient recovery for those experiencing syndrome of the trephined. The recommendations support the need for further research and education, as well as the development of a screening assessment tool that can be used by all members of the multidisciplinary team.