The effect of cranioplasty following decompressive craniectomy on cerebral blood perfusion, neurological, and cognitive outcome

Abstract

OBJECTIVE Decompressive craniectomy is an established therapy for refractory intracranial hypertension. Cranioplasty following decompressive craniectomy not only provides protection to the brain along with cosmetic benefits, but also enhances rehabilitation with meaningful functional recovery of potentially reversible cortical and subcortical damaged areas of the affected as well as the contralateral hemisphere. The aim of the study was to assess neurological and cognitive outcome as well as cerebral blood flow after cranioplasty. METHODS Thirty-four patients admitted for replacement cranioplasty after decompressive craniectomy for head injury were studied prospectively. Clinical, neurological, and cognitive outcomes were assessed by the Glasgow Outcome Scale (GOS), the Glasgow Coma Scale, and a battery of cognitive tests, respectively. Simultaneously, cerebral blood perfusion was assessed by technetium-99m ethyl cysteinate dimer (Tc-ECD) brain SPECT imaging 7 days prior to and 3 months after cranioplasty. RESULTS Prior to cranioplasty 9 patients (26.5%) had GOS scores of 5 and 25 patients (73.5%) had GOS scores of 4, whereas postcranioplasty all 34 patients (100%) improved to GOS scores of 5. Approximately 35.3%-90.9% patients showed cognitive improvement postcranioplasty in various tests. Also, on comparison with brain SPECT, 94% of patients showed improvement in cerebral perfusion in different lobes. CONCLUSIONS Cranioplasty remarkably improves neurological and cognitive outcomes supported by improvement in cerebral blood perfusion.

Predictors of primary autograft cranioplasty survival and resorption after craniectomy

“…A successful CP will restore the contour of the cranium, protect the brain, and ensure a natural ICP, and some patients also show neurological improvement post-CP. 5,6,11,38 Thus, CP has a great potential for improving the patient's quality of life. Although widely regarded as a routine operation, CP often involves serious complications, such as postoperative hemorrhages, surgical site infection (SSI), and, most importantly, resorption of the autologous bone flap.…”

Timing for cranioplasty to improve neurological outcome: A systematic review

“…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.…”

“…In the last few years, researcher interest is moving toward the association of cranioplasty with the recovery of consciousness and cognitive function as well as the timing of performing cranioplasty (Huang et al, ; Shahid et al, ; Songara et al, ). Rish et al () reported that cranioplasty performed within 6 months after DC is associated with poor outcomes, Huang et al () sustained that the timing of cranioplasty is not related to the neurological outcomes of TBI, and Corallo et al found that the neurological recovery is independent from timing and patient's clinical status.…”

“…In the last few years, researcher interest is moving toward the association of cranioplasty with the recovery of consciousness and cognitive function as well as the timing of performing cranioplasty (Huang et al, 2013;Shahid et al, 2018;Songara et al, 2016). Rish et al (1979) reported that cranioplasty performed within 6 months after DC is associated with poor outcomes, Huang et al (2013) (Malcolm et al, 2018).…”

Quantitative and qualitative analysis of bone flap resorption in patients undergoing cranioplasty after decompressive craniectomy

“…A successful cranioplasty and mechanical stabilization of the skull restores the natural cosmesis and cerebral protection while simultaneously contributing to improvements of the cerebral blood flow 17 and neurocognitive outcome, 10,38 which is an especially prominent factor in patients with sinking skin flap syndrome and associated neurological deteriorations. 34 Postoperative complications are nevertheless common, 41,43,44 which is also prevalent in our results: 39.0% of our patients had clinical complications and the implant removal rate was 17.1%.…”