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Objective: To compare the effect of extensive duraplasty and subsequent early cranioplasty on the recovery of neurological function in management of patients with severe traumatic brain injuries received decompressive craniectomy.Methods: The computer-aided designation of titanium armor plate was used as a substitute for the repair of skull defect in all the patients. The patients were divided into three groups. Twenty-three patients were in early cranioplasty group who received extensive duraplasty in craniectomy and subsequent cranioplasty within 3 months after previous operation (Group Ⅰ). Twenty-one patients whose cranioplasty was performed more than 3 months after the first operation were in the group without duraplasty (Group Ⅱ); while the other 26 patients in the group with duraplasty in previous craniotomy (Group Ⅲ). Both the Barthel index of activity of daily living (ADL) 3 months after craniotomy for brain injuries and 1 month after cranioplasty and Karnofsky Performance Score (KPS) at least 6 months after cranioplasty were assessed respectively.Results: The occurrence of adverse events commonly seen in cranioplasty, such as incision healing disturbance,fluid collection below skin flap, infection and onset of postoperative epilepsy was not significantly higher than other 2 groups. The ADL scores at 3 months after craniotomy in Groups Ⅰ-Ⅲ were 58.9±26.7, 40.8±20.2 and 49.2±18.6. The ADL scores at 1 month after cranioplasty were 70.2±25.2, 50.8±24.8 and 61.2±21.5. The forward KPS scores were 75.4±19.0,66.5±24.7 and 57.6±24.7 respectively. The ADL and KPS socres were significantly higher in group Ⅰ than other 2 groups.Conclusion: The early cranioplasty in those with extensive duraplasty in previous craniotomy is feasible and helpful to improving ADL and long-term quality of life in patients with severe traumatic brain injuries.