Cranial defects are a common problem for patients in rehabilitation, most often seen after cerebral hemorrhage or traumatic brain injury, and are a life-saving decompression measure during surgery in the acute phase, but with the recovery of intracranial hypertension, cranial defects no longer have a therapeutic role, but instead are an unfavorable factor affecting the recovery of neurological function after craniocerebral injuries, as well as causing new functional deficits. Generally, textbooks advocate cranial bone repair after three months of trauma surgery, and hospitals say different things about the timing of repair, some advocate three months later, and some advocate six months later, but there is no conclusive evidence that cranial bone repair within three months after trauma surgery is harmful to the human body. We advocate early cranial bone repair, that is, in the cranial defects from the expansion of the flat or depressed on the repair, some in three months, some even in a month, early cranial bone repair benefits are analyzed as follows. First, early cranial bone repair is conducive to the recovery of patients. Cranial defects in patients with cranial defects in the pressure is constantly changing, not only with the heartbeat, breathing in the non-stop fluctuations, and in the sleep, lying down when the defect will be puffed up, in standing activities will collapse, hard stool will also be puffed up, the cerebral cortex in the puffed up will be jammed in the edge of the cranial defects, the collapse will be followed by the subsidence, as the same as a wire repeatedly folded, over time, resulting in functional impairments; cranial defects due to the lack of Due to the lack of cranial protection, the cranial defects are subjected to external atmospheric pressure, and the cortical blood flow is affected at a certain level, and the function of the cortex will be affected by the reduction of blood flow, and if hyperbaric oxygen therapy is performed again, there is a risk of aggravating the pressure on the cerebral cortex. Early cranial repair not only protects the brain from accidental injury and reduces psychological pressure, but also avoids cortical folding movement, improves cortical blood supply, facilitates hyperbaric oxygen therapy, and is conducive to the functional recovery of patients. It is usually believed that the purpose of cranial repair surgery is to restore the integrity of the skull, and it has no therapeutic effect on cognitive disorders, paralysis, aphasia, and mental disorders caused by the patient’s primary disease. This is also what we emphasized to the patient’s family during the preoperative conversation in order to lower the patient’s expectations of the surgery and reduce disputes. According to our observation, some patients have a great degree of improvement in brain function after repair surgery. This can be manifested in the improvement of cognitive impairment, better mental status, better speech impairment, and improved motor function. Some patients are worried about the interruption of rehabilitation therapy, we have made improvements in the details of the perioperative period, such as feeding and water 6 hours after surgery, pulling out the drainage tube for 1 day, getting out of bed after 2 days to continue rehabilitation exercises, absorbable sutures, without removing stitches and so on, without delaying the rehabilitation therapy. Second, early cranial repair to avoid excessive depression of the bone window. With the prolongation of time, the bone window of the skull defect is gradually sunken, and in serious cases, the excessive sunkenness forms a “deep pit”, which causes a lot of trouble to the cranial bone repair surgery, and if the repair is not done directly, often there will be effusion under the repair material, subdural and intracerebral hemorrhage, seizures, etc. After the repair, the bone window of the skull defect will be sunken. The “deep pit” causes a lot of trouble for cranial repair surgery. It is very difficult to flatten the depressed bone window and there is a lack of effective and safe methods to do so. Early repair avoids excessive depression of the bone window and reduces postoperative complications. Thirdly, early cranial repair avoids regression of cerebral cortex function. There are a few patients who underwent cranial bone repair surgery after 6 months, appeared limb activity disorder aggravation or speech, cognitive impairment aggravation, several months of hard work of rehabilitation training efficacy into nothing, we call the cerebral cortex function regression, the imaging examination, there is no effusion, hemorrhage, and other complications, theoretically it is difficult to explain. After analyzing the possible causes of cerebral cortex regression, we believe that it may be caused by a decrease in blood supply to the cerebral cortex. The blood vessels of the scalp may communicate with the blood flow of the cerebral cortex in the absence of the skull, and the peeling of the dermatomuscular flap during repair will cut off the anastomotic blood vessels, resulting in the regression of cortical ischemic function, which is prone to occur in patients with large cranial defects, large cerebral infarcts with decompression of the debridement flap, and smoky disease with temporalis muscle patching, and it is more likely to occur the later the repair surgery is done. So early repair surgery before intracranial and extracranial vascular traffic may avoid regression of cortical function. Scalp vessels may still communicate with the intracranium through the mesh of the titanium plate after repair, which theoretically facilitates the patient’s further recovery. Fourth, early cranial repair is beneficial in reducing subdural fluid. Part of the subdural effusion, and skull defects, especially large cranial defects, pressure imbalance, brain tissue gravity sagging, subdural space widening formation of effusion, puncture suction is ineffective, do repair surgery, the effusion naturally disappears, some subdural effusion has formed a cystic cavity and the subarachnoid space can not be reached, the cystic cavity will be opened in the repair surgery, can also be cured once the effusion. Fifth, early cranial bone repair to avoid temporal muscle atrophy. Cranial defects involving the temporal bone, the temporal muscle attachment point disconnected, the longer the more likely to atrophy, temporal muscle atrophy of patients with obvious repair of the temporal part of the obvious bulge, and the opposite side of the asymmetric, unattractive, family members tend to complain about unsatisfactory cranial contouring, in fact, is the temporal muscle atrophy downward buildup caused by the early repair to avoid temporal atrophy, the contouring of the aesthetics and satisfaction. Sixth, early cranial repair is favorable to the treatment of hydrocephalus. It is theorized that cranial defect is one of the causes of hydrocephalus, and early repair may avoid the formation of hydrocephalus associated with cranial defect. Chronic hydrocephalus often appears 1-2 months after injury, in the case of simultaneous existence of cranial defect and hydrocephalus, cranial repair should be performed first, and it should be operated at an early stage, otherwise, with the progression of hydrocephalus, ventricular enlargement, increased tension of the bone window at the cranial defect, and bulging of the bone window, the treatment becomes tricky, and the repair surgery is no longer possible, and it is impossible to do the shunt surgery to solve the hydrocephalus, and do the repair surgery at the same period of time or in the second stage, both of which The risk of shunt blockage and infection is increased. Shunt surgery should preferably be performed with an adjustable pressure shunt to avoid excessive shunting causing depression of the bone window, which increases the risk of subdural hemorrhage, effusion, and intracerebral hemorrhage in the repair surgery. The cranial pressure should not be lowered preoperatively, and the bone window should be flat or slightly concave, so as to facilitate the apposition of subcutaneous tissues, titanium plates, and meninges, and to reduce the occurrence of subcutaneous effusions, and the pressure of shunt should be adjusted for 1 week postoperatively, to further alleviate the hydrocephalus. In a few cases, the time of repair surgery is delayed: those who have undergone aneurysm clipping, cerebrovascular malformation, and vascular intervention should review the vascular imaging examination to make clear that the lesion has been properly handled before considering repair surgery; those with poorly healed incisions, incision infections, cranial infections, and intracranial infections are delayed in the repair; and those who are combined with cardiorespiratory complications, anemia, diabetes mellitus, malnutrition, and electrolyte disorders are delayed in the repair. In conclusion, we advocate early cranial repair in most cases.