Yoshida K, Furuse M, Izawa A, Iizima N, Kuchiwaki H, Inao S
Department of Neurosurgery, School of Medicine, Nagoya University, Japan.
J Neurol Neurosurg Psychiatry. 1996 Aug;61(2):166-71. doi: 10.1136/jnnp.61.2.166.
Prolonged improvement in neurological and mental disorders has been seen after only cranioplasty in patients initially treated with external decompression for high intracranial pressure. The objective was to evaluate, using 133Xe CT and 31P magnetic resonance spectroscopy (MRS), how restoring the bone itself can influence cerebral blood flow and cerebral energy metabolism after high intracranial pressure is attenuated.
Seven patients (45-65 years old) who had undergone external decompression to prevent uncontrollable intracranial hypertension after acute subarachnoid haemorrhage were evaluated. Cerebral blood flow and metabolic changes were evaluated before and after cranioplasty.
The ratio of phosphocreatine to inorganic phosphate (PCr/Pi), which is a sensitive index of cerebral energy depletion, was calculated and beta-ATP was measured. The cerebral blood flow value in the thalamus was normalised, from 44 (SD 9) to 56 (SD 8) ml/100 g/min (P < 0.01) and the value in the hemisphere increased from 26 (SD 3) to 29 (SD 4) ml/100 g/min on the side with the bone defect. The PCr/Pi ratio improved greatly from 2.53 (SD 0.45) to 3.01 (SD 0.24) (P < 0.01). On the normal side, the values of cerebral blood flow and PCr/Pi increased significantly (P < 0.01) after cranioplasty, possibly due to transneural suppression. The pH of brain tissue was unchanged bilaterally after cranioplasty.
Cranioplasty should be carried out as soon as oedema has disappeared, because a bone defect itself may decrease cerebral blood flow and disturb energy metabolism.
对于最初接受高颅内压减压术治疗的患者，仅行颅骨修补术后可出现神经和精神障碍的长期改善。本研究旨在利用氙-133 CT和磷-31磁共振波谱（MRS）评估在高颅内压减轻后，颅骨修复本身如何影响脑血流和脑能量代谢。
对7例（年龄45 - 65岁）因急性蛛网膜下腔出血行减压术以预防无法控制的颅内高压的患者进行评估。在颅骨修补术前和术后评估脑血流和代谢变化。
计算磷酸肌酸与无机磷酸盐的比值（PCr/Pi），其为脑能量消耗的敏感指标，并测量β-ATP。丘脑的脑血流值恢复正常，从44（标准差9）增至56（标准差8）ml/100 g/min（P < 0.01），骨缺损侧半球的脑血流值从26（标准差3）增至29（标准差4）ml/100 g/min。PCr/Pi比值从2.53（标准差0.45）显著改善至3.01（标准差0.24）（P < 0.01）。在正常侧，颅骨修补术后脑血流和PCr/Pi值显著增加（P < 0.01），可能是由于神经跨突触抑制。颅骨修补术后双侧脑组织pH值无变化。
一旦水肿消失应尽快进行颅骨修补，因为骨缺损本身可能会减少脑血流并扰乱能量代谢。
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