title: Temporal changes in CT perfusion values before and after cranioplasty in patients without symptoms related to external decompression: a pilot study.
abstract: BACKGROUND
  Little is known about hemodynamic disturbances affecting cerebral hemispheres in traumatic brain injury (TBI) after cranioplasty.
  
  
  METHODS
  We prospectively investigated six stable TBI patients who underwent cranioplasty more than 90 days after effective decompressive craniectomy. Computerized tomography perfusion (CTP) studies and evaluation of clinical outcome were performed for each patient before cranioplasty and at 7 days and 3 months after surgery. Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in multiple cortical circular regions positioned in cranioplasty-treated and contralateral hemispheres.
  
  
  RESULTS
  Neither complications associated with cranioplasty nor changes in outcome were observed. On the treated side, CBF and CBV values were higher before and 7 days after cranioplasty than at 3 months after surgery, whereas MTT values were lower at 7 days than at 3 months after surgical treatment.
  
  
  CONCLUSIONS
  Our results indicate that cortical perfusion progressively declines in the cranioplasty treated hemisphere but remains stable in the contralateral hemisphere after surgery and suggest that CTP can represent a promising tool for a longitudinal analysis of hemodynamic abnormalities occurring in TBI patients after cranioplasty. In addition, these data imply a possible role of cranioplasty in restoring flow to meet the prevailing metabolic demand.
authors.affiliation: Neurosurgery Unit, Department of Neurosciences, "S. Chiara" Hospital, APSS Trento, Trento, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Sarubbo
authors.forename: Francesco
authors.initials: F
authors.lastname: Latini
authors.forename: Stefano
authors.initials: S
authors.lastname: Ceruti
authors.forename: Arturo
authors.initials: A
authors.lastname: Chieregato
authors.forename: Christopher
authors.initials: C
authors.lastname: d'Esterre
authors.forename: Ting-Yim
authors.initials: TY
authors.lastname: Lee
authors.forename: Michele
authors.initials: M
authors.lastname: Cavallo
authors.forename: Enrico
authors.initials: E
authors.lastname: Fainardi
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D003131:Combined Modality Therapy; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D056424:Decompressive Craniectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome