КРАНИОПЛАСТИКА ПОСЛЕ ДЕКОМПРЕССИВНОЙ КРАНИЭКТОМИИ: ОПТИМАЛЬНЫЕ СРОКИ, ВЫБОР РЕКОНСТРУКТИВНОГО МАТЕРИАЛА И ВЛИЯНИЕ НА НЕВРОЛОГИЧЕСКОЕ ВОССТАНОВЛЕНИЕ

Abstract

Background. Cranioplasty has traditionally been considered a reconstructive procedure aimed at restoring mechanical brain protection and correcting cranial deformity after decompressive craniectomy. Contemporary clinical and neuroimaging evidence indicates that restoration of cranial integrity may additionally modify cerebral hemodynamics, cerebrospinal fluid dynamics, cognition, and functional recovery. The optimal timing of reconstruction and the choice between autologous bone, titanium, polymethylmethacrylate, polyetheretherketone, and patient-specific implants remain controversial.

Materials and Methods. A structured narrative review was performed using systematic reviews, meta-analyses, prospective cohorts, and retrospective studies evaluating cranioplasty timing, syndrome of the trephined, cerebral perfusion, neurological recovery, autologous bone reconstruction, synthetic implants, infection, bone-flap resorption, hydrocephalus, seizures, and patient-specific three-dimensional implants.

Results. Cranioplasty may improve motor, cognitive, and functional outcomes, particularly in patients with syndrome of the trephined. Reconstruction within the first three months after decompressive craniectomy has been associated with greater functional improvement in several studies, although no universally valid timing threshold exists. Autologous bone offers excellent anatomical compatibility and low initial cost but carries a risk of aseptic resorption. Titanium provides high mechanical strength, polyetheretherketone offers excellent geometric accuracy and favorable imaging characteristics, and polymethylmethacrylate remains an accessible and technically versatile material. Computer-aided and three-dimensional printed patient-specific implants may improve reconstruction of large and complex defects.

Conclusion. Contemporary cranioplasty should be viewed as both a reconstructive and potentially neurorehabilitative intervention. Optimal treatment should be individualized according to neurological status, soft-tissue quality, infection, hydrocephalus, defect size, age, resorption risk, and available reconstructive technology.