• Yu-Ying Wu, Kang Lu, Jui-Sheng Chen, Te-Yuan Chen, Shao-Ang Chu, Cheng-Kai Lin, Hao-Kuang Wang, and I-Fan Lin.
• School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan; Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung, Taiwan.
• World Neurosurg. 2023 Oct 1; 178: e431e444e431-e444.

ObjectiveAdequate brain swelling resolution prior to cranioplasty (CP) is an important yet loosely defined issue. Despite efforts to balance timely CP and patient safety, heterogeneous study methodologies have led to conflicting results. This study aims to standardize this issue through quantifying degree of brain swelling resolution using a proposed Visual CP Scale.MethodsThe proposed Visual CP Scale is validated through a 2-pronged approach. The first prong involves a national survey in Taiwan, where neurosurgeons were surveyed to determine what constitutes a patient's readiness for CP. The second prong involves a large retrospective cohort, where the correlations between timing, degree of brain swelling resolution, and post-CP complication rates, are evaluated.ResultsIn the national Taiwan CP Survey, 124 out of 772 neurosurgeons (17.2%) completed the survey. Respondents who chose higher grades on the Visual CP Scale preferred later CP timings. In the retrospective data, 378 out of 770 (49.1%) patients had pre-CP brain images, allowing for the utilization of the Visual CP Scale. A Visual CP Scale score of greater than or equal to 4 was associated with fewer complications after CP.ConclusionsThe timing of CP should be determined by the degree of brain swelling resolution, not vice versa. The proposed Visual CP Scale offers an objective method for assessing brain swelling resolution, making it an adjuvant tool for clinical decision-making and future research related to CP.Copyright © 2023 Elsevier Inc. All rights reserved.

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