Artikel
Cerebral perfusion changes following cranioplasty
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Autoren
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Daniel Remmel
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Philipp Slotty
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Marcel Alexander Kamp
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Christopher Munoz-Bendix
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Bernd Turowski
- Heinrich-Heine-Universität, Universitätsklinikum, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Neurological improvement after cranioplasty (CP) in patients treated by decompressive craniectomy (DC) is a well-known phenomenon, although the pathophysiological explanation remains unclear. Improvements in cerebral perfusion have been hypothesized and shown in other studies. This study directly measured cerebral perfusion before and after cranioplasty in different underlying pathologies.
Methods: Eighteen patients were included and examined with perfusion CT before and 72h after cranioplasty. Preoperative and postoperative perfusion parameters (MTT, Tmax, CBF, CBV) were statistically analyzed. Different areas of interest (area under the boneflap, area next to bone flap and whole pathologic hemisphere) were compared with the "healthy" contralateral correlate. A subgroup analyses with respect to the indication for primary decompression (subarachnoid haemorrhage SAH n=4, cerebral infarction n=4 and traumatic brain injury TBI n=10) was also performed.
Results: There is a significant reduction of the Tmax (time-to-peak residue function) in the pathological hemisphere(PH) as compared to the contralateral hemisphere. This effect is especially pronounced in the area under bone flap(AUBF) (p = 0.045). No significant differences are seen in other perfusion parameters. The effects of cranioplasty on cerebral perfusion changes are different depending on the primary pathology. While the improvement under the pathological hemisphere is pronounced in patients with TBI and SAH, it is missing in the infarction subgroup. However the infarction subgroup shows an increase in perfusion in the contralateral hemisphere.
Conclusion: The neurological improvement after cranioplasty might correlate with adaptations in cerebral perfusion. These adaptations seem to be depending on the underlying pathology which was leading to DC. Larger numbers of patients in each subgroup are needed to develop a pathophysiological concept of cerebral perfusion changes depending on the underlying pathology.
