Context: Decompressive craniectomy is commonly use as the treatment for medically refractory
intracranial hypertension. Unexpected improvement in patient's neurological status
has been observed among patients that underwent cranioplasty. Restoration of cerebral
blood flow (CBF) hemodynamics is one of the contributing factors. This study was conducted
to determine the impact of cranioplasty on CBF and its correlation with clinical outcome.
Aims: This study was done to evaluate the effect of cranioplasty on CBF with computed tomography
perfusion (CTP). It also aimed to determine the correlation between postcranioplasty
CBF and clinical outcome. Settings and Design: Prospective observational study. Subjects and Methods: All patients had CTP done to determine precranioplasty CBF. CTP was repeated at 6
weeks postcranioplasty and clinical assessment at 6 and 24 weeks postcranioplasty.
Statistical Analysis Used: Data analysis was done using Statistical Package for Social Sciences version 12.0.1.
Results: The median value of the ipsilateral CBF was 48.87 and 61.10 ml/min/100 g at precranioplasty
and 6 weeks postcranioplasty (P < 0.001). Contralateral CBF also showed improvement
from 60.55 to 71.84 ml/min/100 g (P < 0.001). Median value for mini mental state examination
showed a significant difference with value of 22, 25, and 25.5 at precranioplasty,
6 and 24 weeks postcranioplasty (P = 0.001 and P < 0.001). Median value for frontal
assessment battery was 12, 14.5, and 15 (P = 0.002 and P = 0.001). Conclusions: Cranioplasty can remarkably improve cortical perfusion for both ipsilateral and contralateral
hemisphere. Though we are unable to establish strong correlation, between CBF and
clinical outcome, cranioplasty was observed to have a therapeutic role in terms of
clinical outcome improvement.
Key-words:
Cerebral blood flow - clinical outcome - computed tomography perfusion - cranioplasty
