The impact of early cranioplasty on cerebral blood flow and metabolism and its correlation with neurological and cognitive outcome: Prospective multi-center study on 34 patients

Abstract

Background: The main indications for cranial reconstruction following decompressive craniectomy at present are cerebral protection and the cosmetic repair. Many reports about neurological improvement after cranioplasty are now available in the literature; however, the underlying patho-physiological mechanisms are still unknown. Materials and Methods: Thirty four patients undergoing decompressive craniectomy for severe head injury and early cranioplasty were prospectively studied. Clinical outcome was evaluated by GOS, FAB and MMSE, 3 days prior and 1 and 6 months after surgery; Trans-cranial Doppler and 18 FDG PET scan were also performed (to explore local and global brain hemodynamic and metabolic changes) 3 days prior to, and 30 days after cranial reconstruction. Results: Cranioplasty improved local and global cerebral brain perfusion (CBF) as well as brain metabolism in all 34 (100%) patients. Ninety-one % of patients showed also a clear and remarkable neuro-cognitive improvement tested by GOS, FAB and MMSE in the post-cranioplasty period. Conclusion: Cranial reconstruction has an effect upon local as well as global brain CBF and metabolism, constituting probably an essential factor influencing the final functional and especially cognitive outcome in a patient.

Keywords

• Brain cerebral brain perfusion
• brain glucose metabolism
• cranioplasty
• cognitive and functional outcome
• syndrome of the sinking bone flap