title: The influence of decompressive craniectomy for major stroke on early cerebral perfusion.
abstract: OBJECTIVE
  Multiple trials have shown improved survival and functional outcome in patients treated with decompressive craniectomy (DC) for brain swelling following major stroke. It has been assumed that decompression induces an improvement in cerebral perfusion. This observational study directly measured cerebral perfusion before and after decompression.
  
  
  METHODS
  Sixteen patients were prospectively examined with perfusion CT within 6 hours prior to surgery and 12 hours after surgery. Preoperative and postoperative perfusion measurements were compared and correlated.
  
  
  RESULTS
  Following DC there was a significant increase in cerebral blood flow in all measured territories and additionally an increase in cerebral blood volume in the penumbra (p = 0.03). These changes spread as far as the contralateral hemisphere. No significant changes in mean transit time or Tmax (time-to-peak residue function) were observed.
  
  
  CONCLUSIONS
  The presurgical perfusion abnormalities likely reflected local pressure-induced hypoperfusion with impaired autoregulation. The improvement in perfusion after decompression implied an increase in perfusion pressure, likely linked to partial restoration of autoregulation. The increase in perfusion that was observed might partially be responsible for improved clinical outcome following decompressive surgery for major stroke. The predictive value of perfusion CT on outcome needs to be evaluated in larger trials.
authors: Departments of 1 Neurosurgery and.|Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Philipp Jörg
authors: PJ
authors: Slotty
authors: Departments of 1 Neurosurgery and.
authors: Marcel Alexander
authors: MA
authors: Kamp
authors: Departments of 1 Neurosurgery and.
authors: Thomas
authors: T
authors: Beez
authors: Departments of 1 Neurosurgery and.
authors: Henrieke
authors: H
authors: Beenen
authors: Departments of 1 Neurosurgery and.
authors: Hans-Jakob
authors: HJ
authors: Steiger
authors: Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Bernd
authors: B
authors: Turowski
authors: Departments of 1 Neurosurgery and.
authors: Daniel
authors: D
authors: Hänggi
mesh_terms: D000328:Adult; D002560:Cerebrovascular Circulation / Q000502:physiology*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D012720:Severity of Illness Index; D020521:Stroke / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: AU = arbitrary units; CBF = cerebral blood flow; CBV = cerebral blood volume; DC = decompressive craniectomy; ICP = intracranial pressure; MCA = middle cerebral artery; MTT = mean transit time; PCT = perfusion CT; Tmax = time to peak of the residue function; cerebral perfusion; decompressive craniectomy; stroke; traumatic brain injury