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Beneficial impact of early cranioplasty in patients with decompressive craniectomy: evidence from transcranial Doppler ultrasonography

  • Clinical Article - Brain Injury
  • Published:
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Abstract

Background

A cranioplasty (CP) is often performed after decompressive craniectomy (DC) for cosmetic and protective reasons; however, the timing of CP needs to be better evaluated to maximize beneficial outcomes and neurological recovery.

Objective

We investigated the effects and mechanisms of early CP compared to late CP on neurological recovery, from the perspective of cerebral blood flow (CBF).

Methods

This study retrospectively reviewed 43 patients undergoing early (<12 weeks) or late (≥12 weeks) cranioplasty after DC. The CBF velocity was measured by transcranial Doppler ultrasonography and was analyzed prior to and after CP in every patient. Complications were recorded.

Results

The CBF velocity in the middle cerebral artery (MCA) ipsilateral to the CP was increased in both groups and was statistically different between groups (p < 0.05). On the contralateral side, however, the CBF in the MCA was increased in the early CP group, but not the late CP group. Change (expressed as delta, Δ) was defined as the difference in CBF velocity between pre- and postoperative status in the early and late CP groups. A statistically significant difference was detected in the Δ of MCA on the ipsilateral side between the early and late groups. There were no differences in the incidence of complications between groups.

Conclusions

Our results show better post-DC improvements in the CBF of patients receiving CP < 12 weeks after DC, compared to those receiving CP ≥ 12 weeks after DC. Therefore, early CP has potential benefits for cerebral perfusion.

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Abbreviations

CP:

Cranioplasty

DC:

Decompressive craniectomy

CBF:

Cerebral blood flow

MCA:

Middle cerebral artery

ICH:

Intractable intracranial hypertension

CSF:

Cerebrospinal fluid

VP:

Ventriculoperitoneal shunt

CT:

Computed tomography

TCD:

Transcranial Doppler ultrasonography

ICA:

Intracranial carotid artery

MR:

Magnetic resonance

References

  1. Aciduman A, Belen D (2007) The earliest document regarding the history of cranioplasty from the Ottoman era. Surg Neurol 68:349–352, discussion 352–343

    Article  PubMed  Google Scholar 

  2. Archavlis E, Carvi YNM (2012) The impact of timing of cranioplasty in patients with large cranial defects after decompressive hemicraniectomy. Acta Neurochir (Wien) 154:1055–1062

    Article  CAS  Google Scholar 

  3. Beauchamp KM, Kashuk J, Moore EE, Bolles G, Rabb C, Seinfeld J, Szentirmai O, Sauaia A (2010) Cranioplasty after post injury decompressive craniectomy: is timing of the essence? J Trauma 69:270–274

    Article  PubMed  Google Scholar 

  4. Chun HJ, Yi HJ (2011) Efficacy and safety of early cranioplasty, at least within 1 month. J Craniofac Surg 22:203–207

    Article  PubMed  Google Scholar 

  5. Di Stefano C, Sturiale C, Trentini P, Bonora R, Rossi D, Cervigni G, Piperno R (2012) Unexpected neuropsychological improvement after cranioplasty: a case series study. Br J Neurosurg 26:827–831

    Article  PubMed  Google Scholar 

  6. Dujovny M, Aviles A, Agner C, Fernandez P, Charbel FT (1997) Cranioplasty: cosmetic or therapeutic? Surg Neurol 47:238–241

    Article  CAS  PubMed  Google Scholar 

  7. Erdogan E, Duz B, Kocaoglu M, Izci Y, Sirin S, Timurkaynak E (2003) The effect of cranioplasty on cerebral hemodynamics: evaluation with transcranial Doppler sonography. Neurol India 51:479–481

    CAS  PubMed  Google Scholar 

  8. Isago T, Nozaki M, Kikuchi Y, Honda T, Nakazawa H (2004) Sinking skin flap syndrome: a case of improved cerebral blood flow after cranioplasty. Ann Plast Surg 53:288–292

    Article  PubMed  Google Scholar 

  9. Jelcic N, De Pellegrin S, Cecchin D, Puppa AD, Cagnin A (2012) Cognitive improvement after cranioplasty: a possible volume transmission-related effect. Acta Neurochir (Wien) 155:1597–1599

    Article  Google Scholar 

  10. Kuo JR, Wang CC, Chio CC, Cheng TJ (2004) Neurological improvement after cranioplasty—analysis by transcranial doppler ultrasonography. J Clin Neurosci 11:486–489

    Article  PubMed  Google Scholar 

  11. Liang W, Xiaofeng Y, Weiguo L, Gang S, Xuesheng Z, Fei C, Gu L (2007) Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma. J Craniofac Surg 18:526–532

    Article  PubMed  Google Scholar 

  12. Maekawa M, Awaya S, Teramoto A (1999) Cerebral blood flow (CBF) before and after cranioplasty performed during the chronic stage after decompressive craniectomy evaluated by xenon-enhanced computerized tomography (Xe-CT) CBF scanning. No Shinkei Geka 27:717–722

    CAS  PubMed  Google Scholar 

  13. Magnaes B (1976) Body position and cerebrospinal fluid pressure. Part 1: clinical studies on the effect of rapid postural changes. J Neurosurg 44:687–697

    Article  CAS  PubMed  Google Scholar 

  14. Magnaes B (1976) Body position and cerebrospinal fluid pressure. Part 2: clinical studies on orthostatic pressure and the hydrostatic indifferent point. J Neurosurg 44:698–705

    Article  CAS  PubMed  Google Scholar 

  15. Richaud J, Boetto S, Guell A, Lazorthes Y (1985) Effects of cranioplasty on neurological function and cerebral blood flow. Neurochirurgie 31:183–188

    CAS  PubMed  Google Scholar 

  16. Schiffer J, Gur R, Nisim U, Pollak L (1997) Symptomatic patients after craniectomy. Surg Neurol 47:231–237

    Article  CAS  PubMed  Google Scholar 

  17. Schuss P, Vatter H, Marquardt G, Imohl L, Ulrich CT, Seifert V, Guresir E (2012) Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma 29:1090–1095

    Article  PubMed  Google Scholar 

  18. Stelling H, Graham L, Mitchell P (2011) Does cranioplasty following decompressive craniectomy improve consciousness? Br J Neurosurg 25:407–409

    Article  PubMed  Google Scholar 

  19. Suzuki N, Suzuki S, Iwabuchi T (1993) Neurological improvement after cranioplasty. Analysis by dynamic CT scan. Acta Neurochir (Wien) 122:49–53

    Article  CAS  Google Scholar 

  20. Winkler PA, Stummer W, Linke R, Krishnan KG, Tatsch K (2000) Influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism. J Neurosurg 93:53–61

    Article  CAS  PubMed  Google Scholar 

  21. Yadla S, Campbell PG, Chitale R, Maltenfort MG, Jabbour P, Sharan AD (2011) Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery 68:1124–1129, discussion 1130

    PubMed  Google Scholar 

  22. Yamaura A, Sato M, Meguro K, Nakamura T, Uemura K (1977) Cranioplasty following decompressive craniectomy–analysis of 300 cases (author’s transl). No Shinkei Geka 5:345–353

    CAS  PubMed  Google Scholar 

  23. Yoshida K, Furuse M, Izawa A, Iizima N, Kuchiwaki H, Inao S (1996) Dynamics of cerebral blood flow and metabolism in patients with cranioplasty as evaluated by 133Xe CT and 31P magnetic resonance spectroscopy. J Neurol Neurosurg Psychiatry 61:166–171

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, People’s Republic of China

    Jian Song & Guo Zheng Xu

  2. Department of Neurosurgery, Wuhan General Hospital, 627 Wu Luo Road, Wuhan, People’s Republic of China

    Jian Song, Xuehong Mo, Hao Du, He Huang & Guo Zheng Xu

  3. 457 Hospital of PLA, Wuhan, People’s Republic of China

    Min Liu

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  1. Jian Song
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  2. Min Liu
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  3. Xuehong Mo
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  4. Hao Du
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  5. He Huang
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  6. Guo Zheng Xu
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Correspondence to Guo Zheng Xu.

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Song, J., Liu, M., Mo, X. et al. Beneficial impact of early cranioplasty in patients with decompressive craniectomy: evidence from transcranial Doppler ultrasonography. Acta Neurochir 156, 193–198 (2014). https://doi.org/10.1007/s00701-013-1908-5

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  • DOI: https://doi.org/10.1007/s00701-013-1908-5

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