Background Cranioplasty is usually performed for aesthetic, protective and patient comfort reasons. The objective of this study is to examine the effects of cranioplasty on the cerebral hemodynamics and cardiovascular system. Methods Twenty-seven patients who had undergone cra-nioplasty after extensive skull bone removal to prevent uncontrollable intracranial hypertension were included in this study. Arterial blood flow velocities in the middle cerebral artery (MCA) and internal carotid artery (ICA)were assessed by transcranial doppler (TCD). The cardiac functions were evaluated using the echocardiogram. And cerebral blood flow were measured by perfusion CT. Findings The blood flow velocity at the MCA ipsilateral to the cranioplasty was decreased from 50.5±15.4 cm/s pre-operative to 38.1±13.9 cm/s following cranioplasty (p< 0.001) and from 33.1±8.3 cm/s to 26.4±6.6 cm/s at the ICA (p<0.001). The stroke volume was increased from 64.7±18.3 ml/beat, to 73.3±20.4 ml/beat (p<0.001), while the cardiac output and mean arterial blood pressure were unchanged. The cerebral blood flow was increased from 39.1±7.2 ml/100g/min to 44.7±8.9 ml/100g/min on the cranioplasty side (P=0.05).
Conclusions Cranioplasty can get rid of the atmospheric pressure on the brain and increase the cerebral blood flow as well as improve the cardiovascular functions. A skull defect should be corrected, because cranioplasty has not only aesthetic or protective effects but also improves the cardiovascular functions.
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References
Anton H (1980) Function of the heart. In: Schmidt RF, Thews G (eds) Human physiology. Springer, New York, pp 358–96
Beumer J, Firtell DN, Curtis TA (1979) Current concept in cranioplasty. J Prosthet Dent 42:67–77
Carter BS, Ogilvy CS, Candia GJ et al (1997) One-year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery 40:1168–1176
Delashaw JB Jr, Persing JA (1994) Repair of cranial defects. In: Youmans JR (ed) Neurosurgical surgery. 4th edn. WB Saunders, Philadelphia, pp 1853–1864
Dujovny M, Agner C, Aviles A (1999) Syndrome of the trephined: theory and facts. Crit Rev Neurosurg 9:271–278
Dujovny M, Aviles A, Agner C et al (1997) Cranioplasty: cosmetic or therapeutic? Surg Neurol 47:238–241
Dujovny M, Fernandez P, Alperin N et al (1997) Post-cranioplasty cerebrospinal fluid hydrodynamic changes: magnetic resonance imaging quantitative analysis. Neurol Res 19:311–316
Fodstad H, Ekstedt J, Fridén H (1979) CSF hydrodynamic studies before and after cranioplasty. Acta Neurochir Suppl (Wien) 28:514–518
Fodstad H, Love JA, Ekstedt H et al (1984) Effect of cranioplasty on cerebrospinal fluid hydrodynamics in patients with the syndrome of the trephined. Acta Neurochir (Wien) 70:21–30
Grantham EG, Landis HP (1948) Cranioplasty and the post-traumatic syndrome. J Neurosrug 15:19–22
Maekawa M, Awaya S, Teramoto A (1999) Cerebral blood flow (CBF) before and after cranioplasty performed during the chronic stage after decompressive craniectomy evaluated by xenon-enhanced computerized tomography (Xe-CT) CBF scanning. No Shinkei Geka 27:717–722, (In Japanese)
Matsumura H, Shigehara K, Ueno T et al (1996) Cranial defect and decrease in cerebral blood flow resulting from deep contact burn of the scalp in the neonatal period. Burns 22:560–565
Richaud J, Boetto S, Guell A et al (1985) Effects of cranioplasty on neurological function and cerebral blood flow. Neurochirugie 31:183–188
Sanan A, Haines SJ (1997) Repairing holes in the head: a history of cranioplasty. Neurosurgery 40:588–603
Schiffer J, Gur R, Nisim U et al (1997) Symptomatic patients after craniectomy. Surg Neurol 47:231–237
Segal DH, Oppenheim JS, Murovic JA (1994) Neurological recovery after cranioplasty. Neurosurgery 34:729–31
Shapiro K, Fried A, Takei F et al (1985) Effect of the skull and dura on neural axis pressure—volume relationships and CSF hydrodynamics. J Neurosurg 63:76–81
Stula D (1985) Intracranial pressure measurement in large skull defects. Neuorchirurgia (Stuttg) 28:164–169, (In Germany)
Stula D, Muller HR (1980) Cranioplasty after extensive decom-pressive craniotomy with displacement of the cerebral hemisphere. CT analysis Neurochirurgia (Stuttg) 23:41–46
Suga H (1991) Physiological interpretation of negative circumferential tension in vascular walls. Jpn Heart J 32:473–80
Suzuki N, Suzuki S, Iwabuchi T (1993) Neurological improvement after cranioplasty. Analysis by dynamic CT scan. Acta Neurochir (Wien) 122:49–53
Winkler PA, Stummer W, Linke R et al (2000) Influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism. J Neurosurg 93:53–61
Witzleb E (1980) Function of the vascular system. In: Schmidt RF, Thews G (eds) Human physiology. Springer, New York, pp 397–455
Yoshida K, Furuse M, Izawa A et al (1996) Dynamics of cerebral blood flow and metabolism in patients with cranioplasty as evaluated by 133Xe CT and 31P magnetic resonance spectroscopy. J Neurol Neurosurg Psychiatry 61:166–171
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Won, YD. et al. (2008). Cranioplasty effect on the cerebral hemodynamics and cardiac function. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_3
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