Neurological improvement after cranioplasty – analysis by transcranial doppler ultrasonography

Kuo, Jinn‐Rung; Wang, Che-Chuan; Chio, Chung-Ching; Cheng, Tain‐Junn

doi:10.1016/j.jocn.2003.06.005

Cited by 106 publications

(64 citation statements)

References 10 publications

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“…The possible advantages of performing cranioplasty in a more timely fashion may include easier dissection of tissue planes, as well as prevention of negative postcraniectomy sequelae including posttraumatic hydrocephalus, 8 syndrome of the trephined, 31,46 or other neurological complications. 32,61,64 Our analysis in regard to time between craniectomy and cranioplasty revealed a higher risk of both postoperative complications and need for reoperation in those patients treated between 100 and 136 days. It is difficult to rectify this point clinically, and our small number of events in each group limits the strength of any conclusions to be made regarding these data.…”

Section: Time To Cranioplastymentioning

confidence: 79%

“…More recent reports have suggested that the procedure may help optimize neurological recovery, both physiologically and/or clinically. 1,4,11,13,15,18,23,31,32,[44][45][46]57,58,61,64,65,69 However, there is no specific technique or material that has consistently stood alone as superior, and postoperative complication rates vary widely. 62 In the modern era, most reports in the literature regarding cranioplasty have focused on technical aspects of the procedure and have not emphasized overall surgical complications.…”

Section: Discussionmentioning

confidence: 99%

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Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Gooch

Gin²,

Kenning³

et al. 2009

FOC

388

261

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Object Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients. Methods A retrospective chart review was undertaken of all patients who had undergone cranioplasty during a 7-year period. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. Patients were classified as having no complications, any complications, and complications requiring reoperation. The groups were compared to identify risk factors predictive of poor outcomes. Results The authors identified 62 patients who had undergone cranioplasty. The immediate postoperative complication rate was 34%. Of these, 46 patients did not require reoperation and 16 did. Of those requiring reoperation, 7 were due to infection, 2 from wound breakdown, 2 from intracranial hemorrhage, 3 from bone resorption, and 1 from a sunken cranioplasty, and 1 patient's cranioplasty procedure was prematurely ended due to intraoperative hypotension and bradycardia. The only factor statistically associated with need for reoperation was the presence of a bifrontal cranial defect (bifrontal: 8 [67%] of 12, requiring reoperation; unilateral: 8 [16%] of 49 requiring reoperation; p < 0.01) Conclusions Cranioplasty following decompressive craniectomy is associated with a high complication rate. Patients undergoing a bifrontal craniectomy are at significantly increased risk for postcranioplasty complications, including the need for reoperation.

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Section: Time To Cranioplastymentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Gooch

Gin²,

Kenning³

et al. 2009

FOC

388

261

View full text Add to dashboard Cite

show abstract

“…[6][7][8][9][10][11][14][15][16]18,20,21,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Several studies 19,32,[43][44][45][46] have reported an incidence of the syndrome of 1-15% and a time latency of 3-6 months from the DC to the onset of the symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are an increasing number of publications suggesting that cranioplasties may result in neurological improvement via increased cerebral blood flow (CBF), and an improvement of cerebrospinal fluid (CSF) dynamics and cerebral metabolism. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Of these, the reported neurological improvement appears to be primarily associated with the CBF improvement. Nevertheless, quantitative assessment of blood flow with, for example, Xenon-enhanced computerized tomography (Xe-CT), 9 depicts a ''snapshot'' of the patient's CBF at a singular moment, but whether those changes are a static process irrespective of time or body posture or rather a dynamic event is unknown.…”

mentioning

confidence: 99%

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography

Paredes

Castaño

Cepeda

et al. 2016

Journal of Neurotrauma

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Cranioplasties are performed to protect the brain and correct cosmetic defects, but there is growing evidence that this procedure may result in neurological improvement. We prospectively studied cranioplasties performed at our hospital over a 5-year period. The National Institute of Health Stroke Scale and Barthel index were recorded prior to and within 72 h after the cranioplasty. A perfusion computed tomography (PCT) and transcranial Doppler sonography (TCDS) were performed prior to and 72 h after the surgery. For the PCT, regions irrigated by the anterior cerebral artery, the middle cerebral artery (MCA), the posterior cerebral artery, and the basal ganglia were selected, as well as the mean values for the hemisphere. The sonography was performed in the sitting and the supine position for the MCA and internal carotid. The velocities, pulsatility index, resistance index, and Lindegaard ratio (LR) were obtained, as well as a variation value for the LR (DLR = LR sitting -LR supine). Fifty-four patients were included in the study. Of these, 23 (42.6%) patients presented with objective improvement. The mean cerebral blood flow of the defective side (m-CBF-d) increased from 101.86 to 117.17 mL/100 g/min ( p = 0.064), and the m-CBF of the healthy side (m-CBF-h) increased from 128.14 to 145.73 mL/100 g/min ( p = 0.028). With regard to the TCDS, the DLR was greater on the defective side prior the surgery in those patients who showed improvement (1.295 vs. -0.714; p = 0.002). Cranioplasty resulted in clinical improvement in 40% of the patients, with an increase in the post-surgical CBF. The larger variations in the LR when the patient is moved from the sitting to the supine position might predict the clinical improvement.

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“…Reconstruction is performed to protect the brain, re-establish normal skull contour and, in some cases, reverse the altered physiological state that may occur following craniotomy, the so-called 'syndrome of the trephined' (3)(4)(5)(6).…”

Section: Discussionmentioning

confidence: 99%

A technique for intraoperative creation of patient-specific titanium mesh implants

Sunderland¹,

Edwards²,

Mainprize³

et al. 2015

CAN J PLAST SURG

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C alvarial reconstruction following trauma, tumour excision or craniotomy is a common procedure performed by craniofacial surgeons and neurosurgeons. Alloplastic cranioplasty using materials such as titanium mesh, polymethyl methacrylate (PMMA) and polyether ether ketone, offers many advantages over autologous cranioplasty including unlimited availability, elimination of donor site morbidity, permanent shape and volume retention, and relative ease of manipulation during surgery (1). In current practice, there are two primary methods of alloplastic cranioplasty: manual intraoperative contouring of the alloplastic cranioplasty material to fit the skull defect in situ; or use of prefabricated, patient-specific implants.Simple skull defects are adequately reconstructed by manual intraoperative shaping of titanium mesh or molding of PMMA in situ. However, accurate restoration of normal skull shape by manual contouring is exceedingly difficult for large defects with complex surface geometry. Prefabricated patient-specific implants, designed using a patient's computed tomography (CT) data to precisely restore the missing anatomy, are increasing in popularity as a surgical solution for these more complex cranial defects. These implants reduce surgical complexity, decrease operative times, minimize exposure and risk of contamination, and have resulted in improved cosmesis and patient satisfaction (1,2).The fabrication of custom implants normally relies on preoperative processing of the patient's CT data, the computer-assisted design of a virtual implant model and subsequent manufacture of the implant. The implant is prefabricated well in advance of surgery for a stable, unalterable skull defect that must be clearly defined before the planned operative procedure. Herein lies the major disadvantage of prefabricated, patient-specific cranioplasty implants. An unanticipated intraoperative finding requiring modification of the defect, renders the implant useless. More importantly, in all surgical procedures in which the size of the defect is not known before surgery, prefabricated implants cannot be used. Patient-specific implants are, therefore, not available to patients undergoing ablative tumour surgery, trauma surgery, or any cranial vault reconstructions potentially requiring intraoperative resection or modification.The optimal method for alloplastic cranioplasty would enable costeffective creation of a patient-specific implant with the capacity for intraoperative modification. The present article describes a technique that uses a patient's CT scan data to create a custom forming tool (ie, mold) that enables intraoperative creation of a custom titanium mesh implant. These implants have the unique capacity for intraoperative modification in the event that the size of the defect is unknown preoperatively, or if alteration of an existing skull defect is required. Representative surgical cases will be presented, demonstrating the ability of this technique to achieve anatomical restoration of virtually any calvarial shape and...

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Neurological improvement after cranioplasty – analysis by transcranial doppler ultrasonography

Cited by 106 publications

References 10 publications

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography

A technique for intraoperative creation of patient-specific titanium mesh implants

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