Cranioplasty effect on the cerebral hemodynamics and cardiac function.
BACKGROUND
Cranioplasty is usually performed for aesthetic, protective and patient comfort reasons. The objective of this study is to examine the effects of cranioplasty on the cerebral hemodynamics and cardiovascular system.


METHODS
Twenty-seven patients who had undergone cranioplasty after extensive skull bone removal to prevent uncontrollable intracranial hypertension were included in this study. Arterial blood flow velocities in the middle cerebral artery (MCA) and internal carotid artery (ICA) were assessed by transcranial doppler (TCD). The cardiac functions were evaluated using the echocardiogram. And cerebral blood flow were measured by perfusion CT.


RESULTS
The blood flow velocity at the MCA ipsilateral to the cranioplasty was decreased from 50.5 +/- 15.4 cm/s preoperative to 38.1 +/- 13.9 cm/s following cranioplasty (p < 0.001) and from 33.1 +/- 8.3 cm/s to 26.4 +/- 6.6 cm/s at the ICA (p < 0.001). The stroke volume was increased from 64.7 +/- 18.3 ml/beat, to 73.3 +/- 20.4 ml/beat (p < 0.001), while the cardiac output and mean arterial blood pressure were unchanged. The cerebral blood flow was increased from 39.1 +/- 7.2 ml/100g/min to 44.7 +/- 8.9 ml/100g/min on the cranioplasty side (P = 0.05).


CONCLUSIONS
Cranioplasty can get rid of the atmospheric pressure on the brain and increase the cerebral blood flow as well as improve the cardiovascular functions. A skull defect should be corrected, because cranioplasty has not only aesthetic or protective effects but also improves the cardiovascular functions.
Won
Yoo-Dong
YD
Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Yoo
Do-Sung
DS
Kim
Ki-Tae
KT
Kang
Suck-Gu
SG
Lee
Sang-Bock
SB
Kim
Dal-Soo
DS
Hahn
Seong-Tai
ST
Huh
Pil-Woo
PW
Cho
Kyung-Suck
KS
Park
Chun-Kun
CK
D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002536:Cerebral Arteries / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012886:Skull / Q000002:abnormalities* / Q000601:surgery*; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult