Multimodal imaging of recovery of functional networks associated with reversal of paradoxical herniation after cranioplasty

Abstract

Cranioplasty following decompressive craniectomy is reported to result in improved blood flow, cerebral metabolism, and concomitant neurological recovery. We used multimodal functional imaging technology in a patient with marked neurological recovery after cranioplasty, specifically, imaging of functional MRI resting state networks, auditory responses, and cerebral metabolism before and after cranioplasty. Significant functional changes observed in the images correlated with the subject’s neurological recovery. Our results suggest a link between recovery of cerebral metabolism and intrinsic brain mechanisms of cerebral vascular integration and resting state networks identified with functional MRI following cranioplasty.

Disorders of consciousness after acquired brain injury: the state of the science

“…197 The novel neuroimaging and electrophysiological technologies await large-scale, multicentre validation studies. Future studies should also follow patients longitudinally and focus on multimodal imaging, 198,199 combining and integrating information over time. 200,201 These techniques can provide additional information to clarify the clinical significance of ambiguous behavioural signs, 202 assess the effect of therapeutic interventions, and inform patient selection for clinical trials.…”

Sinking flap syndrome with abdominal pain: an atypical presentation

“…Other possible explanations are disturbance in cerebral blood flow or metabolic changes that improve postcranioplasty. These changes have been reported ipsilateral to the bone defect and also in the non-operated, contralateral side, especially in the thalamus 11 12…”

Syndrome of the trephined following bifrontal decompressive craniectomy: Implications for rehabilitation

“…This alteration in cerebral elastance and compliance is reversed following cranioplasty and CSF hydrodynamics are restored [27]. Finally, multimodal functional imaging has been used to demonstrate significant changes in functional networks and cerebral metabolism that occur before and after cranioplasty [23,28]. Overall, whilst the exact mechanism has not been established it is perhaps not particularly surprising that the presence of a large skull defect can cause neurological impairment given the significant physiological derangements that have been demonstrated.…”