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The effect of cranioplasty following decompressive craniectomy on cerebral blood perfusion, neurological, and cognitive outcome
journal contribution
posted on 2022-11-07, 04:45 authored by A H Shahid, M Mohanty, N Singla, B R Mittal, Sunil GuptaSunil GuptaOBJECTIVE Decompressive craniectomy is an established therapy for refractory intracranial hypertension. Cranioplasty following decompressive craniectomy not only provides protection to the brain along with cosmetic benefts, but also enhances rehabilitation with meaningful functional recovery of potentially reversible cortical and subcortical damaged areas of the affected as well as the contralateral hemisphere. The aim of the study was to assess neurological and cognitive outcome as well as cerebral blood?ow after cranioplasty. METHODS Thirty-four patients admitted for replacement cranioplasty after decompressive craniectomy for head injury were studied prospectively. Clinical, neurological, and cognitive outcomes were assessed by the Glasgow Outcome Scale (GOS), the Glasgow Coma Scale, and a battery of cognitive tests, respectively. Simultaneously, cerebral blood perfusion was assessed by technetium-99m ethyl cysteinate dimer (99mTc-ECD) brain SPECT imaging 7 days prior to and 3 months after cranioplasty. RESULTS Prior to cranioplasty 9 patients (26.5%) had GOS scores of 5 and 25 patients (73.5%) had GOS scores of 4, whereas postcranioplasty all 34 patients (100%) improved to GOS scores of 5. Approximately 35.3%-90.9% patients showed cognitive improvement postcranioplasty in various tests. Also, on comparison with brain SPECT, 94% of patients showed improvement in cerebral perfusion in different lobes. CONCLUSIONS Cranioplasty remarkably improves neurological and cognitive outcomes supported by improvement in cerebral blood perfusion.
History
Journal
Journal of NeurosurgeryVolume
128Pagination
229 - 235Publisher DOI
ISSN
0022-3085eISSN
1933-0693Usage metrics
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99mTc-ECD = technetium-99m ethyl cysteinate dimerCBF = cerebral blood flowCBP = cerebral blood perfusionCOWAT = Controlled Oral Word Association TestDSST = Digit Symbol Substitution TestDST = Digit Span TestGCSGCS = Glasgow Coma ScaleGOSGOS = Glasgow Outcome ScaleRAVLT-DR, RAVLT-IR = Rey Auditory Verbal Learning Test–delayed recall, RAVLT–immediate recallSPECTTMT-A, TMT-B = Trail-Making Test, Parts A and Bcognitive outcomecranioplastydecompressive craniectomytrauma
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