• Jon Kooi Mah and Rosman Azmin Kass.
• Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kelantan, Malaysia.
• Asian J Neurosurg. 2016 Jan 1; 11 (1): 15-21.

ContextDecompressive craniectomy 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.AimsThis 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.Settings And DesignProspective observational study.Subjects And MethodsAll patients had CTP done to determine precranioplasty CBF. CTP was repeated at 6 weeks postcranioplasty and clinical assessment at 6 and 24 weeks postcranioplasty.Statistical Analysis UsedData analysis was done using Statistical Package for Social Sciences version 12.0.1.ResultsThe median value of the ipsilateral CBF 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).ConclusionsCranioplasty 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.

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