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We read with great interest the systematic review by Spencer et al. [1] regarding the risk factors for the development of seizures after cranioplasty in patients that sustained traumatic brain injury. The authors have revealed a pooled incidence and risk factors of post-cranioplasty seizures (PCS). We really appreciate the interesting review for their conclusion, it’s very useful to have a better understanding of PCS. However, after reading this article, we would like to highlight 2 important questions that it raises.