The Evaluation of the Effect of Cranioplasty on Cerebral Metabolism Using F-18 FDG PET/CT

Abstract

Introduction:Decompressive craniectomy (DC) is commonly used as the treatment for refractory intracranial hypertension. The indications for cranioplasty after DC are cosmetic repair and, mainly, restoration of cerebral protection. Unexpected improvement in patient’s neurological status has been observed among patients that underwent cranioplasty. This study was conducted to determine the impact of cranioplasty on cerebral metabolism and its correlation with clinical outcome.Methods:Twelve patients who underwent DC for various reasons underwent positron emission tomography/computed tomography (PET/CT) with F-18 labeled fluorodeoxyglucose (FDG) before and after cranioplasty.Results:There were 11 (92%) male patients and 1 (8%) female patient in the study. The mean age was 46.8±14.1 years. The most common indication was trauma (58%), while the most frequently affected side was right (67%). The cerebral metabolism evaluated by FDG-PET/CT was found to be significantly decreased in the hemisphere ipsilateral to the trauma compared with the contralateral hemisphere (3.87 vs 2.72, p=0.012). All patients showed improvement in one or more anatomic areas with cranioplasty (median: 6, minimum: 3, maximum: 8). Cranioplasty did not cause a significant change in FDG uptake in both hemispheres (ipsilateral p=0.814, contralateral p=0.308). Nevertheless, a general improvement and decrease in symptoms were observed in all patients before and after cranioplasty.Conclusion:Though we are unable to demonstrate a significant increase in the cerebral metabolism, cranioplasty was observed to have a therapeutic role in terms of clinical outcome improvement.

Keywords

• Cerebral metabolism
• cranioplasty
• decompressive craniectomy