Abstract Background Cranioplasty represents a surgical intervention meticulously designed to tackle the dangers of increased intracranial pressure caused by traumatic brain injury. At its core, the procedure aims to facilitate skull decompression and dural relaxation, essential steps that accommodate the expanded cerebral volume due to brain swelling. Methods This study explored the efficacy of cranioplasty in preventing compressive hypoperfusion, venous hypertension, and the irreversible deterioration of neuronal structures. As a holistic approach, cranioplasty not only protects the brain and improves esthetic appearance but also plays a crucial role in enhancing cortical and subcortical functions as well as cerebrospinal fluid dynamics. Results Our research underscores the efficacy of cranioplasty in bolstering cerebral blood flow perfusion and neurocognitive capabilities among TBI cohorts. Particularly enlightening are the discernible disparities in postoperative cerebral blood flow perfusion observed across various categories of TBI patients, accentuating the procedure’s impact. Conclusion The findings strongly advocate for the transformative potential of cranioplasty in elevating cerebral blood flow within severely injured cerebral regions, ultimately optimizing neurological and cognitive functions with a profound impact.