Early Cranioplasty in Patients With Posttraumatic Decompressive Craniectomy and Its Correlation with Changes in Cerebral Perfusion Parameters and Neurocognitive Outcome

Songara, Abhishek; Gupta, Rakesh; Jain, Nilesh L.; Rege, Shrikant; Masand, Ravi

doi:10.1016/j.wneu.2016.07.003

Cited by 23 publications

(20 citation statements)

References 22 publications

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“…An improvement of neurocognitive functions was observed after cranioplasty (especially if done within 3 months from trauma). Interestingly, serial perfusion CTs (performed in a subgroup of nine patients) also confirmed an improvement in cerebral perfusion in both the operated and the contralateral side [26,30].…”

Section: Cerebral Perfusion Pressure and Perfusion Ctmentioning

confidence: 64%

“…A literature research including the terms "traumatic brain injury" and "perfusion CT" or "perfusion computed tomography" returned 185 results. Critical screening of the abstracts selected 18 papers that were considered as pertinent and relevant to this review and therefore they were analyzed and discussed in detail [16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Table 1 illustrates the studies' characteristics and main findings.…”

Section: Perfusion Ct and Traumatic Brain Injurymentioning

confidence: 99%

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Perfusion Computed Tomography in Traumatic Brain Injury

Bendinelli¹,

Cooper²,

Abel³

et al. 2018

Traumatic Brain Injury - Pathobiology, Advanced Diagnostics and Acute Management

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Introduction: Almost 50 years ago, computed tomography (CT) revolutionized the management of traumatic brain injury (TBI) by imagining intracranial hematomas. This allowed prompt and accurate selection of patients who would benefit from surgical evacuation. Since then, unenhanced CT has been the gold standard imaging modality for patients with acute TBI. Today, multidetector CT can track intravenous contrasts flowing through brain creating maps that depict the speed and the amount of blood at capillary level. This imaging modality takes the name of perfusion CT. Perfusion CT is routinely used during the hyperacute phase of patients suffering from stroke to diagnose areas of penumbra (poorly perfused but still viable brain tissue) that may benefit from revascularization. Here, we summarize the current status of the research on the role of perfusion CT in patients suffering from TBI. Methods:Inclusive literature research conducted on PubMed using the keywords "perfusion," "computed tomography" and "traumatic brain injury." Only articles published in English were considered for this review. Conclusion:With a minimal logistic effort, perfusion CT provides clinicians with a multitude of additional information. Most patients with TBI show altered perfusion patterns. The maps generated with perfusion CT can predict the final size of cerebral contusions better than unenhanced CT. These maps can be used to clarify the status of brain autoregulation and possibly guide targeted therapies for intracranial hypertension. The integrity of the blood-brain barrier can also be evaluated with this technology and this might be crucial to predict and treat brain edema. Furthermore, perfusion maps can help physician to promptly and accurately predict the long-term functional outcomes of patients suffering from both mild and severe TBI.

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Section: Cerebral Perfusion Pressure and Perfusion Ctmentioning

confidence: 64%

Section: Perfusion Ct and Traumatic Brain Injurymentioning

confidence: 99%

Perfusion Computed Tomography in Traumatic Brain Injury

Bendinelli¹,

Cooper²,

Abel³

et al. 2018

Traumatic Brain Injury - Pathobiology, Advanced Diagnostics and Acute Management

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“…After reading them, one article was excluded because reported duplicate patients (Honeybul, Janzen, Kruger, & Ho, ), who were included in a more recent and larger simple size study (Honeybul, Janzen, Kruger, & Ho, ), whereas two articles were excluded for inadequate study design (Huang et al, ; Liang et al, ). Although we contacted eight authors for further information regarding missing data (Bender et al, ; Di Stefano et al, ; Honeybul et al, ; Jasey, Ward, Lequerica, & Chiaravalloti, ; Shahid, Mohanty, Singla, Mittal, & Gupta, ; Songara, Gupta, Jain, Rege, & Masand, ; Stelling, Graham, & Mitchell, ; Su et al, ), only four of them were able to provide original individual data useful for our meta‐analysis (Di Stefano et al, ; Honeybul et al, ; Jasey et al, ; Songara et al, ). At the end of selection, six articles and two systematic reviews (Malcolm et al, ; Xu et al, ) have been included in the present study.…”

Section: Resultsmentioning

confidence: 99%

“…Four of selected articles included both early and late cranioplasty groups: Two studies (Kim, Kim, & Hyun, ; Songara et al, ) used 90 days as threshold for dividing patients into early and late groups, whereas two studies (Corallo et al, ; Di Stefano et al, ) used a threshold of 180 days. For two studies (Honeybul et al, ; Jasey et al, ), we set at 3 months the threshold to split the patients in two groups, as the median timings were 99 days and 105 days, respectively.…”

Section: Resultsmentioning

confidence: 99%

Timing for cranioplasty to improve neurological outcome: A systematic review

et al. 2018

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IntroductionCranioplasty is a surgical technique applied for the reconstruction of the skullcap removed during decompressive craniectomy (DC). Cranioplasty improves rehabilitation from a motor and cognitive perspective. However, it may increase the possibility of postoperative complications, such as seizures and infections. Timing of cranioplasty is therefore crucial even though literature is controversial. In this study, we compared motor and cognitive effects of early cranioplasty after DC and assess the optimal timing to perform it.MethodsA literature research was conducted in PubMed, Web of Science, and Cochrane Library databases. We selected studies including at least one of the following test: Mini‐Mental State Examination, Rey Auditory Verbal Learning Test immediate and 30‐min delayed recall, Digit Span Test, Glasgow Coma Scale, Glasgow Outcome Scale, Coma Recovery Scale‐Revised, Level of Cognitive Functioning Scale, Functional Independence Measure, and Barthel Index.ResultsSix articles and two systematic reviews were included in the present study. Analysis of changes in pre‐ and postcranioplasty scores showed that an early procedure (within 90 days from decompressive craniectomy) is more effective in improving motor functions (standardized mean difference [SMD] = 0.51 [0.05; 0.97], p‐value = 0.03), whereas an early procedure did not significantly improve neither MMSE score (SMD = 0.06 [−0.49; 0.61], p‐value = 0.83) nor memory functions (SMD = −0.63 [−0.97; −0.28], p‐value < 0.001). No statistical significance emerged when we compared studies according to the timing from DC.ConclusionsIt is believed that cranioplasty performed from 3 to 6 months after DC may significantly improve both motor and cognitive recovery.

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“…Tasiou et al51) reported delayed cranioplasty preference is associated with efforts to decrease postoperative infection, especially for traumatic brain injuries. Recently, several reports recommend early cranioplasty, because it was found that cranioplasty improved clinical outcomes 364247). In the aspect of postoperative infection, multinational prospective designed study says no difference exists of the infection rates between early and delayed cranioplasty 42).…”

Section: Optimal Timing Of Cranioplastymentioning

confidence: 99%

Review of Cranioplasty after Decompressive Craniectomy

Cho

Kang

2017

Korean J Neurotrauma

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Cranioplasty is an in evitable operation conducted after decompressive craniectomy (DC). The primary goals of cranioplasty after DC are to protect the brain, achieve a natural appearance and prevent sinking skin flap syndrome (or syndrome of the trephined). Furthermore, restoring patients' functional outcome and supplementing external defects helps patients improve their self-esteem. Although early cranioplasty is preferred in recent year, optimal timing for cranioplasty remains a controversial topic. Autologous bone flaps are the most ideal substitute for cranioplasty. Complications associated with cranioplasty are also variable, however, post-surgical infection is most common. Many new materials and techniques for cranioplasty are introduced. Cost-benefit analysis of these new materials and techniques can result in different outcomes from different healthcare systems.

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Early Cranioplasty in Patients With Posttraumatic Decompressive Craniectomy and Its Correlation with Changes in Cerebral Perfusion Parameters and Neurocognitive Outcome

Cited by 23 publications

References 22 publications

Perfusion Computed Tomography in Traumatic Brain Injury

Perfusion Computed Tomography in Traumatic Brain Injury

Timing for cranioplasty to improve neurological outcome: A systematic review

Review of Cranioplasty after Decompressive Craniectomy

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