Comprehensive cognitive and cerebral hemodynamic evaluation after cranioplasty

Fernanda Coelho, Arthur Maynart Oliveira, Wellingson Silva Paiva, Fabio Rios Freire, Vanessa Tome Calado, Robson Luis Amorim, Iuri Santana Neville, Almir Ferreira de Andrade, Edson Bor-Seng-Shu, Renato Anghinah, Manoel Jacobsen Teixeira, Fernanda Coelho, Arthur Maynart Oliveira, Wellingson Silva Paiva, Fabio Rios Freire, Vanessa Tome Calado, Robson Luis Amorim, Iuri Santana Neville, Almir Ferreira de Andrade, Edson Bor-Seng-Shu, Renato Anghinah, Manoel Jacobsen Teixeira

Abstract

Decompressive craniectomy is an established procedure to lower intracranial pressure and can save patients' lives. However, this procedure is associated with delayed cognitive decline and cerebral hemodynamics complications. Studies show the benefits of cranioplasty beyond cosmetic aspects, including brain protection, and functional and cerebrovascular aspects, but a detailed description of the concrete changes following this procedure are lacking. In this paper, the authors report a patient with trephine syndrome who underwent cranioplasty; comprehensive cognitive and cerebral hemodynamic evaluations were performed prior to and following the cranioplasty. The discussion was based on a critical literature review.

Keywords: cognition; cranioplasty; decompressive craniotomy; neuropsychological test; perfusion CT; traumatic brain injury.

Figures

Figure 1
Figure 1
Computed tomography perfusion with four regions of interest selected in each cerebral hemisphere. Note: Three superficial regions and one positioned in the basal ganglia. Abbreviations: R, right; P, posterior.
Figure 2
Figure 2
Cranial computed tomography before performing cranioplasty. Note: We observed a significant depression of the skin flap with erasing wrinkles and superficial cortical compression.
Figure 3
Figure 3
Perfusion computed tomography before (top) and after (bottom) surgery showing the changes in the three parameters: CBF, CBV, and MTT. Note: In this image we can also see a restructuring of the cortical mantle of the left frontal region. Abbreviations: CBF, cerebral blood flow; CBV, cerebral blood volume; MTT, mean transit time.

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