After a cranioplasty: recovery from the first days to the first months

After surgery, patients are often monitored overnight in a step-down unit, then on the ward. The stay lasts up to five days on average, longer if needed, and imaging checks the position of the implant before discharge ^[1]. In one US centre, the average stay was 4.5 to 6 days depending on the operating team ^[2].

Headache and tiredness are common in the first days and are treated. If a drain was placed under the skin, it is removed within the first days.

• Scar: keep it clean and dry; stitches or staples are usually removed one to two weeks after surgery, depending on the team.
• Hair: washing resumes when the team allows, without rubbing the scar.
• Rest: tiredness can last several weeks; naps are normal.
• Exertion: avoid strenuous exercise and heavy lifting, then resume gradually ^[1].
• Driving: not until your doctor agrees ^[1].
• Swelling: slight swelling around the scar is common in the first days; it should go down.

Contact the team promptly in case of ^[1]:

• fever;
• increasing swelling, or a red and warm scar;
• fluid leaking from the scar;
• severe headache that does not respond to treatment.

Call the emergency services for a seizure or signs of stroke: weakness on one side of the body, difficulty speaking ^[1].

After a craniectomy, hydrocephalus can appear or become apparent after cranioplasty: the international consensus recommends close monitoring ^[3].

Recovery from the operation usually takes one to three months. Follow-up visits take place at about one week, one month and three months, more often if there is a complication ^[1].

Returning to work depends mainly on the original injury and the job. In a Polish series of 112 patients, 89 had been employed before their care and only 2 worked between craniectomy and cranioplasty; after reconstruction, 93 were fit to work without restriction and 47 were employed at follow-up ^[4].

Families play an important part: watching the scar, spotting warning signs, supporting the gradual return to activity.

The implant is permanent. Once the scar has healed, it needs no particular care: declare it before an MRI and keep your operation report.

Each team has its own instructions, adapted to the operation and your condition: they always take precedence over these general guidelines.