Effects of Cranioplasty After Decompressive Craniectomy on Neurological Function and Cerebral Hemodynamics in Traumatic Versus Nontraumatic Brain Injury

Rynkowski, Carla Bittencourt; Robba, Chiara; Loreto, Melina Silva de; Theisen, Ana Carolina Wickert; Kolias, Angelos; Finger, Guilherme; Czosnyka, Marek; Bianchin, Marino Muxfeldt

doi:10.1007/978-3-030-59436-7_17

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…Previous studies have shown that if an intensive and multidisciplinary rehabilitation program starts early, then the cognitive and motor recovery will be better. Therefore, it is possible to attribute part of the recovery occurring immediately after the CP to this surgical procedure, while the gradual improvement of cognitive and functional outcomes is probably due to a competitive effect between the surgical procedure and rehabilitation [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Can Cranioplasty Be Considered a Tool to Improve Cognitive Recovery Following Traumatic Brain Injury? A 5-Years Retrospective Study

Corallo

Buono

Calabrò

et al. 2021

JCM

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Cranioplasty (CP) is a neurosurgical intervention of skull repairing following a decompressive craniectomy. Unfortunately, the impact of cranioplasty on cognitive and motor function is still controversial. Fifteen TBI subjects aged 26–54 years with CP after decompressive craniectomy were selected in this observational retrospective study. As per routine clinical practice, a neuropsychological evaluation carried out immediately before the cranioplasty (Pre CP) and one month after the cranioplasty (T0) was used to measure changes due to CP surgery. This assessment was performed each year for 5 years after discharge in order to investigate long-term cognitive changes (T1-T5). Before cranioplasty, about 53.3% of subjects presented a mild to severe cognitive impairment and about 40.0% a normal cognition. After CP, we found a significant improvement in all neuropsychological test scores. The more significant differences in cognitive recovery were detected after four years from CP. Notably, we found significant differences between T4 and T0-T1, as well as between T5 and T0-T1-T2 in all battery tests. This retrospective study further suggests the importance of CP in the complex management of patients with TBI showing how these patients might improve their cognitive function over a long period after the surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Can Cranioplasty Be Considered a Tool to Improve Cognitive Recovery Following Traumatic Brain Injury? A 5-Years Retrospective Study

Corallo

Buono

Calabrò

et al. 2021

JCM

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“…In addition to the effect of intracranial pressure on cerebrospinal fluid circulation, the study also found that cerebral blood flow velocity decreased after bone flap removal, and the larger the bone flap was, the slower the blood flow velocity ( 53 , 54 ). The Richaud study also concluded that CP could increase cortical blood flow on the side of the skull defect by 15–30% ( 55 , 56 ). Second, Yamaura found that 95% of patients with DC had accompanying EEG changes, and 60% of these patients had EEG improvements after CP, as well as clinical seizures ( 57 ).…”

Section: Discussionmentioning

confidence: 99%

The compensatory mechanism and clinical significance of hydrocephalus after cranioplasty

Qiu

Wang²,

Chen³

et al. 2023

Front. Neurol.

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ObjectiveCranioplasty (CP) and ventriculoperitoneal shunt (VPS) are procedures required after decompression of the flap (DC) to protect the cranial frame and prevent hydrocephalus. This study evaluated the safety and efficacy of different surgical sequences of CP and VPS after DC and identified risk factors for necessary permanent VPS.MethodsFrom January 2017 to December 2021, valid follow-up data were collected in 192 cases. The observation group preferred CP, and then evaluated whether to receive VPS according to the progress of hydrocephalus. the control group was prioritized for VPS and continued with CP after 1 week. The improvement of hydrocephalus symptoms, follow-up outcomes, and post-operative complications before and after surgery were compared between the two groups, and univariate analysis was used to determine the risk factors for necessary permanent risk factors for VPS.ResultsThere were 86 cases (44.8%) in the observation group, who received CP first, while 106 cases (55.2%) in the control group received VPS and CP, respectively. There was no significant difference between the two groups according to Barthel index, FMAS, Mrs, GCS, and Evans index, and there was no statistical difference in complications between the two groups. However, in the observation group, hydrocephalus disappeared after CP operation in 29 cases (33.7%), and finally avoided VPS. Univariate analysis showed that the main etiology was related to the size of the skull defect, the distance of the talus margin relative to the flap to the midline, and lumbar puncture pressure was a predictor of the need for permanent VPS.ConclusionThis study provides detailed information on the efficacy and complications of different sequences of preferential CP or VPS after DC surgery. We found that priority CP reduced the incidence of VPS surgery without affecting surgical outcomes and complications.

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“…The increase in CBF after CP can also promote neurological and cognitive recovery. 59 64 76) A systemic review of 21 articles confirmed that CP improved CBF in a total of 205 cases. 64) A prospective study on patients who underwent craniectomy due to TBI also confirmed that not only improve CBF after CP, but the difference in CBF between the hemispheres also decreased, as demonstrated by CT perfusion performed before and after CP.…”

Section: Literature Reviewmentioning

confidence: 93%

“… 40) The increase in CBF after CP could also be a contributing factor in promoting cognitive recovery. 59 64 76) A study using transcranial Doppler to measure CBF in the MCA and ICA found that the group that underwent early CP had a more significant increase in CBF at the craniectomy site and improved contralateral CBF compared to the group that underwent delayed CP. 67) …”

Section: Literature Reviewmentioning

confidence: 99%

Recent Updates on Controversies in Decompressive Craniectomy and Cranioplasty: Physiological Effect, Indication, Complication, and Management

Kim

Choo

Jeong

et al. 2023

Korean J Neurotrauma

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Decompressive craniectomy (DCE) and cranioplasty (CP) are surgical procedures used to manage elevated intracranial pressure (ICP) in various clinical scenarios, including ischemic stroke, hemorrhagic stroke, and traumatic brain injury. The physiological changes following DCE, such as cerebral blood flow, perfusion, brain tissue oxygenation, and autoregulation, are essential for understanding the benefits and limitations of these procedures. A comprehensive literature search was conducted to systematically review the recent updates in DCE and CP, focusing on the fundamentals of DCE for ICP reduction, indications for DCE, optimal sizes and timing for DCE and CP, the syndrome of trephined, and the debate on suboccipital CP. The review highlights the need for further research on hemodynamic and metabolic indicators following DCE, particularly in relation to the pressure reactivity index. It provides recommendations for early CP within three months of controlling increased ICP to facilitate neurological recovery. Additionally, the review emphasizes the importance of considering suboccipital CP in patients with persistent headaches, cerebrospinal fluid leakage, or cerebellar sag after suboccipital craniectomy. A better understanding of the physiological effects, indications, complications, and management strategies for DCE and CP to control elevated ICP will help optimize patient outcomes and improve the overall effectiveness of these procedures.

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Effects of Cranioplasty After Decompressive Craniectomy on Neurological Function and Cerebral Hemodynamics in Traumatic Versus Nontraumatic Brain Injury

Cited by 7 publications

References 21 publications

Can Cranioplasty Be Considered a Tool to Improve Cognitive Recovery Following Traumatic Brain Injury? A 5-Years Retrospective Study

Can Cranioplasty Be Considered a Tool to Improve Cognitive Recovery Following Traumatic Brain Injury? A 5-Years Retrospective Study

The compensatory mechanism and clinical significance of hydrocephalus after cranioplasty

Recent Updates on Controversies in Decompressive Craniectomy and Cranioplasty: Physiological Effect, Indication, Complication, and Management

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