Agrawal Manish, Mishra Keshav
Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Surg Neurol Int. 2024 Jun 21;15:204. doi: 10.25259/SNI_1003_2023. eCollection 2024.
Cranioplasty has been useful in treating the symptoms associated with the "Sunken skin flap syndrome" post decompressive craniectomy, for which various mechanisms have been proposed. In this study, we aim to assess the changes in the cerebral blood flow and intracranial cerebrospinal fluid (CSF) dynamics post cranioplasty and correlate with the improvement in the neurocognitive status.
Computed tomography perfusion and cine magnetic resonance imaging studies were done to study the changes in cerebral perfusion and CSF flow dynamics postcranioplasty. The cognitive status was assessed using Montreal cognitive assessment, mini-mental state examination, and frontal assessment battery scores in the preoperative period and at 1 and 6 months follow-up.
There was a significant change in cognitive status postcranioplasty, both at 1 and 6 months follow-up, which was associated with a significant improvement in cerebral blood flow, decreased mean transit time, and improvement in the mean and peak CSF flow velocities at the foramen of Magendie and aqueduct of Sylvius.
Cranioplasty leads to a marked improvement in cerebral hemodynamics, which is more significant on the ipsilateral side. It also leads to increased CSF turnover and improved CSF circulation. Improved cerebral perfusion and, more importantly, CSF dynamics may be responsible for the demonstrable improvement in the neurocognition in the postcranioplasty period.
颅骨修补术在治疗减压性颅骨切除术后与“凹陷皮瓣综合征”相关的症状方面很有用，对此已提出了各种机制。在本研究中，我们旨在评估颅骨修补术后脑血流量和颅内脑脊液（CSF）动力学的变化，并将其与神经认知状态的改善相关联。
进行计算机断层扫描灌注和电影磁共振成像研究，以研究颅骨修补术后脑灌注和脑脊液流动动力学的变化。在术前以及术后1个月和6个月随访时，使用蒙特利尔认知评估、简易精神状态检查和额叶评估量表评分来评估认知状态。
颅骨修补术后1个月和6个月随访时，认知状态均有显著变化，这与脑血流量显著改善、平均通过时间缩短以及在马根迪孔和中脑导水管处的脑脊液平均流速和峰值流速提高有关。
颅骨修补术可导致脑血流动力学显著改善，同侧更为明显。它还会导致脑脊液周转率增加和脑脊液循环改善。改善的脑灌注，更重要的是脑脊液动力学，可能是颅骨修补术后神经认知明显改善的原因。
