title: The impact of cranioplasty on cerebral blood flow and its correlation with clinical outcome in patients underwent decompressive craniectomy.
abstract: BACKGROUND
  Decompressive craniectomy is commonly use as the treatment for medically refractory intracranial hypertension. Unexpected improvement in patient's neurological status has been observed among patients that underwent cranioplasty. Restoration of cerebral blood flow (CBF) hemodynamics is one of the contributing factors. This study was conducted to determine the impact of cranioplasty on CBF and its correlation with clinical outcome.
  
  
  OBJECTIVE
  This study was done to evaluate the effect of cranioplasty on CBF with computed tomography perfusion (CTP). It also aimed to determine the correlation between postcranioplasty CBF and clinical outcome.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  All patients had CTP done to determine precranioplasty CBF. CTP was repeated at 6 weeks postcranioplasty and clinical assessment at 6 and 24 weeks postcranioplasty.
  
  
  METHODS
  Data analysis was done using Statistical Package for Social Sciences version 12.0.1.
  
  
  RESULTS
  The median value of the ipsilateral CBF was 48.87 and 61.10 ml/min/100 g at precranioplasty and 6 weeks postcranioplasty (P < 0.001). Contralateral CBF also showed improvement from 60.55 to 71.84 ml/min/100 g (P < 0.001). Median value for mini mental state examination showed a significant difference with value of 22, 25, and 25.5 at precranioplasty, 6 and 24 weeks postcranioplasty (P = 0.001 and P < 0.001). Median value for frontal assessment battery was 12, 14.5, and 15 (P = 0.002 and P = 0.001).
  
  
  CONCLUSIONS
  Cranioplasty can remarkably improve cortical perfusion for both ipsilateral and contralateral hemisphere. Though we are unable to establish strong correlation, between CBF and clinical outcome, cranioplasty was observed to have a therapeutic role in terms of clinical outcome improvement.
authors.affiliation: Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kelantan, Malaysia.
authors.forename: Jon Kooi
authors.initials: JK
authors.lastname: Mah
authors.affiliation: Department of Neurosurgery, Hospital Sungai Buloh, Jalan University, Selangor, Malaysia.
authors.forename: Rosman Azmin
authors.initials: RA
authors.lastname: Kass
keywords: Cerebral blood flow; clinical outcome; computed tomography perfusion; cranioplasty