| Objective CTP is currently the most mature and non-invasive and most convenient way to measure the brain blood perfusion monitoring, this study before and after the test by checking CTP of specific cortical cerebral blood flow changes in cranioplasty, the comparison of different surgical period in different primary disease skull defect repair relationships between brain perfusion index, to understand the differences over the control group in the early repair in improving cerebral perfusion and other aspects, to grasp the opportunity and provide a theoretical basis for treatment.Methods In this study,38 cases of decompressive craniectomy patients 1-6 months after surgery,26 males and 12 females, patient age from 20 to 61 years, mean age is 41 years. Traffic accident is 25 cases, fall injury is 8 cases,5 cases of hypertensive intracerebral hemorrhage were adopted in the first 15 days before cranioplasty two days after the 64-slice CT brain perfusion scan, to check the synchronous line CTP neurological deficit scores. Cranioplasty surgery patients before and after contrast perfusion index, before and after the ipsilateral and contralateral cranioplasty cerebral cortex, basal ganglia, thalamus, and the index variation of CTP. Divided into two groups according to the timing of surgery, ultra-early cranioplasty group (less than equal to 1.5 months) and control group (3 months Group), by CTP examination, collected before and after surgical repair of skull defects in cerebral blood flow in the cerebral cortex specific values, changes in the defect area of the cerebral cortex CBF groups of patients before and after surgery, surgery contrast timing group and less than equal to 1.5 months in 3 months groups after surgery in patients with preoperative neurological deficits and improve the situation, the occurrence of postoperative complications rate changes, etc. during surgery; contrast epidural, skull different primary disease hematoma, brain contusion, intracerebral hematoma as a result of the defect before and after repair cortical perfusion.Results Skull defect repair preoperative ipsilateral CBF was statistically significant compared with the contralateral. (P< 0.05). Ipsilateral CBF preoperatively compared with post-operatively from 52.57±14.40ml/100g/min increased to 70.55±15.00ml/100g/min postoperative, and there are statistically significant difference between two groups (P<0.05). CBF in thalamus and basal ganglia before and after surgery was not statistically significant (P<0.05). CBF in ultra-early cranioplasty group and the control group was statistically significant difference (P<0.05). There was no statistically significant difference in complications, surgery duration and bleeding between the two groups(P>0.05). Neurological deficit scores before and after the surgery was statistically significant (P<0.05). Comparison of different primary disease in different groups was statistically significant difference in CBF (P<0.05).Conclusion 1. Compare to cortex hypoperfusion in the ipsilateral cortex pre-cranioplasty, postoperative hypoperfusion significantly improved.2. By comparing super early repair group and the control group CBF changes, ipsilateral cortex was significantly higher blood perfusion in ultra-early repair group.3. Comparison of the two groups statistically significant improvement from nerve function, ultra-early repair group were significantly better than the control group. The complication rate, surgery duration, bleeding were no statistically significant difference, so the timing of surgical repair of skull defects in the absence of significant contraindications soon as repair; patients can maximize the recovery of neurological function.4. Different primary disease (epidural hematoma, hematoma, brain contusion, intracerebral hematoma) skull defects before surgery cortex low perfusion defects in patients with primary brain injury severity significantly correlated. That intracerebral hematoma> cerebral contusion> epidural hematoma. Corresponding increase in CBF after area, a significant degree intracerebral hematoma> cerebral contusion> epidural hematoma. So, in the more severe brain injury patients, in the absence of contraindications to surgery cases, the skull should be promoted ultra-early defect repair.5. Compared to ultra-early cranioplasty early cranioplasty, a more appropriate timing of surgery can significantly improve cerebral perfusion in cerebral cortex of defect area, thus contributing to neuronal functional recovery and reduce long-term neurological deficits and continue onset of brain damage occurs, the incidence of adverse reactions and complications did not differ significantly. Therefore, we recommend that from the need to restore cerebral perfusion, neurological rehabilitation of these two aspects of starting premise under strict indications skull patch as soon as possible. |
PDF Full Text Request