Article

Cranioplasty after decompressive craniectomy in patients suffering
from severe head injury often leads to a functional improvement although, to
date, the pathophysiology of this phenomenon remains unclear. A few hypotheses
have been proposed. The impact of cranioplasty on cerebral perfusion could be one
explanation. We have evaluated the impact of cranioplasty on the functional
status of patients undergoing decompressive craniectomy for severe head injury
with its influence on cerebral perfusion. METHODS: Twenty-four
patients undergoing craniectomy for severe head injury were included in this
multi-centric and prospective study. All of them had a cranioplasty within 12
weeks following decompressive craniectomy. A clinical and radiological evaluation
was performed prior to and after cranioplasty. Neurological and cognitive
evaluation was performed with the Glasgow Outcome Score (GOS), the Frontal
Assessment Battery (FAB) and the Mini Mental State Examination (MMSE).
Radiological evaluation was performed by perfusion CT scan and transcranial
Doppler. RESULTS: A statistically significant neurological and cognitive
improvement was observed in 92% of patients at 6 months follow-up (F-U). Brain
perfusion was improved at 6 weeks F-U, predominantly in the affected hemisphere.
Systolic and diastolic blood velocity flow were improved in both middle cerebral
arteries. CONCLUSION: Cranioplasty after decompressive craniectomy for patients
suffering from severe head injury probably improves the functional outcome of
these patients, thanks to a global improvement of cerebral perfusion.
CI - Copyright (c) 2012 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS