Beneficial impact of early cranioplasty in patients with decompressive craniectomy: evidence from transcranial Doppler ultrasonography

Abstract

Background: A cranioplasty (CP) is often performed after decompressive craniectomy (DC) for cosmetic and protective reasons; however, the timing of CP needs to be better evaluated to maximize beneficial outcomes and neurological recovery.

Objective: We investigated the effects and mechanisms of early CP compared to late CP on neurological recovery, from the perspective of cerebral blood flow (CBF).

Methods: This study retrospectively reviewed 43 patients undergoing early (<12 weeks) or late (≥ 12 weeks) cranioplasty after DC. The CBF velocity was measured by transcranial Doppler ultrasonography and was analyzed prior to and after CP in every patient. Complications were recorded.

Results: The CBF velocity in the middle cerebral artery (MCA) ipsilateral to the CP was increased in both groups and was statistically different between groups (p < 0.05). On the contralateral side, however, the CBF in the MCA was increased in the early CP group, but not the late CP group. Change (expressed as delta, Δ) was defined as the difference in CBF velocity between pre- and postoperative status in the early and late CP groups. A statistically significant difference was detected in the Δ of MCA on the ipsilateral side between the early and late groups. There were no differences in the incidence of complications between groups.

Conclusions: Our results show better post-DC improvements in the CBF of patients receiving CP < 12 weeks after DC, compared to those receiving CP ≥ 12 weeks after DC. Therefore, early CP has potential benefits for cerebral perfusion.