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  1. The impact of cranioplasty on cerebral blood flowand its correlation with clinical outcome in patientsunderwent decompressive craniectomyJon Kooi Mah, Rosman Azmin Kass1Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kelantan,1Department of Neurosurgery, Hospital Sungai Buloh, Jalan University, Selangor, Malaysia

  2. Context • Decompressivecraniectomy 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.

  3. Aims: 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.

  4. Settings and Design: Prospective observational study.

  5. Subjects and Methods All patients aged over 18 and up to 65 years who underwent DC (Decompressivecraniectomy) for intracranial hypertension and requiring reconstructive cranioplastyat Hospital Sungai Buloh from 1 September 2013 to 1 September 2014. They or guardians must also consent to be part of this study. Patient with previous bilateral DC, allergy to contrast, pregnant, or nursing woman will be excluded

  6. Statistical Analysis Used: Data analysis was done using Statistical Package for Social Sciences version 12.0.1.

  7. Results The median value of the ipsilateralCBF (Cerebral Blood Flow) 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).

  8. Discussion DC has been widely used for more than a century for the treatment of medically refractory intracranial hypertension for multiple reasons. This procedure is efficient, not complicated and straight forward. DC managed to effectively reduce ICP in 85% of patients who have intracranial hypertension refractory to conventional medical treatment. Long‑term results (3 years) and good clinical outcome are also seen in up to 40% of patients who were otherwise most likely to die.

  9. 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.

  10. THANK YOU

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