Wen Liang, Lou Hai-Yan, Xu Jun, Wang Hao, Huang Xin, Gong Jiang-Biao, Xiong Bin, Yang Xiao-Feng
a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China .
b Department of Radiology , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China.
Brain Inj. 2015;29(13-14):1654-60. doi: 10.3109/02699052.2015.1075248. Epub 2015 Oct 29.
A large cranial defect following decompressive craniectomy (DC) is a common sequela in patients with severe traumatic brain injury (TBI). Such a defect can cause severe disturbance of cerebral blood flow (CBF) regulation. This study investigated the impact of cranioplasty on CBF in these patients.
Patients who underwent DC and secondary cranioplasty were prospectively studied for a severe TBI. CT perfusion was used to measure CBF before and after cranioplasty. The basal ganglia, parietal lobe and occipital lobe on the decompressed side were chosen as zones of interest for CBF evaluation.
Nine patients representing nine cranioplasty procedures were included in the study. Before cranioplasty, CBF on the decompressed side was lower than that on the contralateral side. During the early stage (10 days) after cranioplasty, CBF on the decompressed side was increased and this increase was significant in the parietal and occipital lobe. CBF was also increased on the contralateral side. In addition, the difference in CBF between the contralateral side and the decompressed side was reduced after cranioplasty. Further, the CT perfusion showed that the CBFs decreased again 3 months post-cranioplasty among four cases, but was still higher than those before cranioplasty.
This study indicates that cranioplasty may increase CBF and benefit the recovery in patients with DC for TBI.
减压性颅骨切除术后出现的大面积颅骨缺损是重型颅脑损伤（TBI）患者常见的后遗症。这种缺损可导致脑血流（CBF）调节严重紊乱。本研究调查了颅骨修补术对这些患者脑血流的影响。
对接受减压性颅骨切除术及二期颅骨修补术的重型颅脑损伤患者进行前瞻性研究。采用CT灌注成像测量颅骨修补术前、后的脑血流。选择减压侧的基底节、顶叶和枕叶作为评估脑血流的感兴趣区。
本研究纳入了9例行颅骨修补术的患者。颅骨修补术前，减压侧的脑血流低于对侧。在颅骨修补术后早期（10天），减压侧的脑血流增加，且在顶叶和枕叶增加显著。对侧的脑血流也增加。此外，颅骨修补术后对侧与减压侧之间的脑血流差异减小。此外，CT灌注成像显示，4例患者在颅骨修补术后3个月脑血流再次下降，但仍高于颅骨修补术前。
本研究表明，颅骨修补术可能增加脑血流，并有利于重型颅脑损伤减压性颅骨切除术后患者的恢复。
