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

Abstract

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.

The impact of implant material and patient age on the long-term outcome of secondary cranioplasty following decompressive craniectomy for severe traumatic brain injury

“…Once the brain swelling has subsided, the surgical skull defect must be bridged [4]. In the past, the use of autologous calvarial bone (ACB) was considered the gold standard for secondary cranioplasty (CP).…”

Use of a Doppler‐Based Pulsatility Index to Evaluate Cerebral Hemodynamics in Neurocritical Patients After Hemicraniectomy

“…To further explore the utility of the MCA PI for assessment of cerebral hemodynamics, we drew probability charts of the associations between the ipsilateral MCA PI and ICP and CPP for ICPs exceeding 20, 25, and 30 mm Hg and CPPs lower than than 70, 60, and 50 mm Hg by various MCA PI values. Although the optimal CPP of neurocritical patients remains unclear, CPPs lower than 50 mm Hg should be avoided . As the charts show, an extremely high MCA PI indicated a dangerous ICP elevation or CPP reduction.…”

“…For example, one animal experiment revealed a 2‐way correlation between the PI and CVR under different conditions . Moreover, we had little knowledge about the effect of craniectomy (rather than a craniectomy‐induced ICP reduction) or cranioplasty on the MCA PI, and the surgery (craniectomy or cranioplasty) may alter cerebral hemodynamics . Additionally, we found no significant correlation between the MCA PI and the CPP ( P > .05), and the MCA PI poorly predicted the CPP (AUC <0.75).…”

Cognitive and Functional Outcomes of Early Versus Delayed Cranioplasty after Decompressive Craniectomy

“…The CP-associated complication rates between early (< 3 months), and late (> 6 months) CP was significantly higher among patients undergoing late CP. 37 Chaturvedi et al (2016) studied and analyzed complications following CP after DC, retrospectively, and found that mortality rate was 1.35% and overall complication rate 31%. 38 In the study of Andrabi et al (2017), complications were noted in 15.25% (n = 36) of the patients; wound infection/dehiscence 6.78% (n = 16) was the most common complication encountered.…”