The Study Of Cranioplasty On Cerebral Blood Flow And Its Correlation With Clinical Outcome

Objective: This study was done to evaluate the effect of cranioplasty on CBF with computed tomography perfusion(CTP). It also aimed to determine the correlation between postcranioplasty CBF and clinical outcome.Methods: The clinical data of twenty-two patients who underwent cranioplasty at the neurosurgery of the second hospital of Hebei medical university from the period of October 2014 to June 2015. The measurements of cerebral blood flow with CT perfusion have been performed respectively to these patients at 3 days before and 6 weeks after cranioplasty. The clinical outcome assessment mini mental state examination(MMSE), Glasgow Outcome Score(GOS), and frontal assessment battery(FAB) were done at at precranioplasty, 6 and 24 weeks postcranioplasty, respectively. Then examine the relationship between the change of cerebral blood flow and clinical outcome by analyzing cerebral blood flow changes on brain cortex after cranioplasty and the changes of GOS, MMSE, FAB before and after cranioplasty.Results:1 A statistically significant improvement in CBF was noted for both ipsilateral and contralateral hemisphere. For the ipsilateral hemisphere, mean cortical CBF was 46.13(SD 5.88) ml/min/100 g at precranioplasty, improved to mean cortical CBF of 63.53(SD 6.13) ml/min/100 g at 6 weeks postcranioplasty. Similarly, contralateral hemisphere also documented improvement in mean cortical CBF with 59.74(SD 4.57) ml/min/100 g at precranioplasty to 81.37(SD 4.00) ml/min/100 g at 6 weeks postcranioplasty.Both of these findings were statistically significant with P < 0.001(Wilcoxon signed-rank test).2 Mean value for mini mental state examination showed a significantdifference with value of 21.91(SD 2.43), 24.64(SD 1.84) and 25.95(SD 1.17)at precranioplasty, 6 and 24 weeks postcranioplasty(P < 0.001 and P < 0.001).And the mean value for frontal assessment battery was 11.95(SD 1.50),14.82(SD 1.26) and 15.77(SD 1.27) at precranioplasty, 6 and 24 weeks postcranioplasty.Both the differences were statistically significant with P <0.001.3 The mean value of GOS showed no statistically significant difference between precranioplasty, 6 weeks and 24 weeks postcranioplasty with mean value were 3.09(SD 0.81), 3.18(SD 0.80) and 3.23(SD 0.75), respectively.4 There was no strong correlation between CBF and clinical outcome(GOS, FAB, and MMSE) at 6 weeks postcranioplasty(Spearman's correlation test, P > 0.05).Conclusions:1 Cranioplasty can remarkably improve cortical perfusion for both ipsilateral and contralateral hemisphere.2 Though we are unable to establish strong correlation, between CBF and clinical outcome, cranioplasty was observed to have a therapeutic role in terms of clinical outcome improvement.