title: Early Cranioplasty in Patients With Posttraumatic Decompressive Craniectomy and Its Correlation with Changes in Cerebral Perfusion Parameters and Neurocognitive Outcome.
abstract: BACKGROUND
  Decompressive craniectomy is a life-saving procedure in many patients after traumatic brain injury. Delayed recovery in such patients can be attributed to various causes. Cranioplasty (CP) helps in early improvement of neurocognitive function along with better brain protection and cosmesis. The mechanism responsible for this functional improvement and the ideal time to perform cranial reconstruction is less understood.
  
  
  METHODS
  We studied 16 patients who underwent CP after decompressive craniectomy (DC) for traumatic brain injury. These patients were divided in 2 groups, early and late CP, depending on the interval between DC and CP. Three months was the cutoff time for early CP. Neurocognitive status was assessed by Glasgow Coma Scale, Glasgow Outcome Scale, and Mini-Mental State Examination scores prior to and after CP. Computed tomography (CT) perfusion was done to correlate the improvement in neurologic status and CT perfusion parameters.
  
  
  RESULTS
  We observed that there was a positive influence of CP on neurologic and psychologic function in all of the patients. The neurocognitive improvement after CP was more remarkable in the early CP group. More complications were noted in patients in the late CP group. Brain perfusion after CP showed improvement in all parameters in both of the groups, both on the operated and contralateral side.
  
  
  CONCLUSIONS
  Neurocognitive improvement is noted after CP in all of the patients. CP should be offered once the brain edema subsides, at the earliest. Improved cerebral perfusion may be the key factor for the improved functional outcome.
authors.affiliation: Department of Neurosurgery, Sri Aurobindo Institute of Medical Sciences & P.G. Institute, Indore, M.P., India. Electronic address: dr.abhineuro2011@gmail.com.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Songara
authors.affiliation: Department of Neurosurgery, Sri Aurobindo Institute of Medical Sciences & P.G. Institute, Indore, M.P., India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, Sri Aurobindo Institute of Medical Sciences & P.G. Institute, Indore, M.P., India.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Jain
authors.affiliation: Department of Neurosurgery, Sri Aurobindo Institute of Medical Sciences & P.G. Institute, Indore, M.P., India.
authors.forename: Shrikant
authors.initials: S
authors.lastname: Rege
authors.affiliation: Department of Radiodiagnosis, CHL Hospital, Indore, M.P., India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Masand
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D003399:Craniotomy / Q000379:methods*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019965:Neurocognitive Disorders / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D013223:Statistics as Topic; D016896:Treatment Outcome
keywords: CT perfusion; Cranioplasty; Decompressive craniectomy; Neurocognition