The effect of cranioplasty on cerebral hemodynamics: evaluation with transcranial Doppler sonography.
BACKGROUND
The purpose of cranioplasty is not only cosmetic repair but also neurological improvement. The effect of cranioplasty on the cerebral hemodynamics flow has not been investigated by ultrasonographic techniques.


OBJECTIVE
To investigate changes of cerebral hemodynamics after cranioplasty in patients with cranial defect using transcranial Doppler sonography (TCDS).


METHODS
The Departments of Neurosurgery and Radiology of a university hospital.


METHODS
A prospective clinical study.


METHODS
We prospectively examined the cerebral hemodynamics with TCDS pre- and postoperatively in 18 patients with cranial defect who underwent cranioplasty. All postoperative studies were done between the 7th and 15th day after cranioplasty. The anterior cerebral artery was examined through the transtemporal and transorbital windows, the middle cerebral artery through the transtemporal window, and the posterior cerebral artery through the transforaminal window. Bilaterally, the peak systolic, end diastolic and mean blood flow velocities of these arteries were measured.


METHODS
Wilcoxon matched-pairs signed-ranks test.


RESULTS
Before cranioplasty all the velocities ipsilateral to the cranial defect were significantly low, while in the contralateral side they were near normal. Ipsilateral low cerebral blood flows increased and reached normal levels (P<0.05) after cranioplasty. During the follow-up, neurological improvement was observed.


CONCLUSIONS
Cranioplasty is carried out not only for preserving normal appearances and physical barrier but also for neurological improvement. This should be explained by the normalization of cerebral hemodynamics.
Erdogan
E
E
Gulhane Military Medical Academy, Department of Neurosurgery, Ankara, Turkey. eerdogan@gata.edu.tr
Düz
B
B
Kocaoglu
M
M
Izci
Y
Y
Sirin
S
S
Timurkaynak
E
E
D000328:Adult; D002560:Cerebrovascular Circulation; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012886:Skull / Q000293:injuries / Q000601:surgery*; D017585:Ultrasonography, Doppler, Transcranial