The Overlooked Role of Nutrition in Recovery after Cranioplasty Surgery: Where We Are and Where We Must Go? A Critical Narrative Review

BACKGROUND: Cranioplasty is a common reconstructive neurosurgical procedure with postoperative complication rates up to 40%, including infections, delayed wound healing, and bone resorption. Although perioperative nutritional status is a recognized determinant of surgical outcomes across specialties and nutrition is incorporated into ERAS pathways, focused research on comprehensive nutritional assessment and structured perioperative nutrition protocols for cranioplasty is limited. OBJECTIVE: This narrative review aims to address this gap by synthesizing evidence from related surgical fields and underscoring the need for targeted research on nutrition in cranioplasty. METHODS: We performed a narrative review of the literature by searching PubMed, Embase, and Web of Science (inception-March 2025) for peer-reviewed systematic reviews, meta-analyses, and original studies addressing nutritional status in surgical patients, and synthesizing evidence from adjacent fields to evaluate implications for cranioplasty. RESULTS: Our search found no prospective clinical studies explicitly designed to assess the impact of perioperative nutritional assessment or interventions on cranioplasty outcomes; existing cranioplasty reports are predominantly retrospective or reference nutrition without standardized measurement or implementation. By contrast, robust evidence from general, plastic, orthopedic, and neurosurgical settings indicates that preoperative nutrition screening, targeted supplementation, and integrated perioperative protocols reduce infectious and noninfectious complications, shorten length of stay, and improve wound and bone healing. CONCLUSION: We conclude that prospective, well-designed studies are needed to define validated nutritional assessment tools, determine optimal timing and composition of nutritional support, and develop reproducible implementation strategies tailored to cranioplasty patients.