Browsing by Subject "Cranioplasty"

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    Clinical improvement after cranioplasty and its relation to body position and cerebral hemodynamics
    (Springer, 2021-10-09) Paredes, Igor; Alén, José Antonio F.; Castaño León, Ana María; Gómez, Pedro Antonio; Jiménez Roldán, Luis; Panero, Irene; Eiriz Fernández, Carla; García Pérez, Daniel; Moreno, Luis Miguel; Esteban Sinovas, Olga; González León, Pedro; Pérez Núñez Ángel; Nunarriz, Pablo M.; Lagares de Toledo, Alfonso; Lagares, Alfonso; Farmacología; Facultades de la UMU::Facultad de Medicina
    Cranioplasty after decompressive craniectomy (DC) has been found to improve the neurological condition. The underlying mechanisms are still unknown. The aim of this study is to investigate the roles of the postural changes and atmospheric pressure (AP) in the brain hemodynamics and their relationship with clinical improvement. Seventy-eight patients were studied before and 72 h after cranioplasty with cervical and transcranial color Doppler ultrasound (TCCS) in the sitting and supine positions. Craniectomy size, shape, and force exerted by the AP (torque) were calculated. Neurological condition was assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Barthel index. Twenty-eight patients improved after cranioplasty. Their time elapsed from the DC was shorter (214 vs 324 days), preoperative Barthel was worse (54 vs 77), internal carotid artery (ICA) mean velocity of the defect side was lower while sitting (14.4 vs 20.9 cm/s), and torque over the craniectomy was greater (2480.3 vs 1464.3 N*cm). Multivariate binary logistic regression showed the consistency of these changes. TCCS findings were no longer present postoperatively. Lower ICA (defect side) velocity in the sitting position correlates significantly with clinical improvement. Greater torque exerted by the AP might explain different susceptibilities to postural changes, corrected by cranioplasty.
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    Effects of cranioplasty in cerebral blood perfusion using quantification with 99m-Tc HMPAO SPECT-CT
    (Wiley, 2022-10-17) Galiana, Álvaro; Ruiz, Sebastián; Alén, J.F.; Gómez Grande, Adolfo; Panero, Irene; Vega, Diana; García Pérez, Daniel; Gutiérrez, Elena; Romero, Carmen; Lagares, Alfonso; Tabuenca, María José; Paredes, Igor; Farmacología; Farmacia
    Background and Purpose: Syndrome of the trephined or sinking skin flap syndrome is an underdiagnosed condition of craniectomized patients that usually improves after cranioplasty. Among the pathophysiological theories proposed, the changes of cerebral blood perfusion (CBP) caused by cranial defects might have a role in the neurological deficiencies observed. We aim to assess the regional cortex changes in CBP after cranioplasty with Technetium 99m hexamethylpropylene-amine oxime (99mTc-HMPAO) SPECT-CT. Methods: Twenty-eight craniectomized patients subject to cranioplasty were studied with 99mTc-HMPAO SPECT-CT in three different times, before cranioplasty, a week, and 3 months after. The images were processed with quantification software comparing CBP of 24 cortical areas with a reference area, and with a database of controls. A mixed effects model and T-Student were used. Results: CBP increased significantly in both hemispheres after cranioplasty, either using ratio (β = .019, p-value = .030 first postsurgical SPECT-CT and β = .021, p-value = .015 in the second study, vs. presurgical) or Z-score (β = .220, p-value = .026 and β = .279, p-value = .005, respectively). Nine areas of the damaged side had a significant lower CBP ratio and Z-score than the undamaged. Posterior cingulate showed an increased CBP ratio (p-value = .034) and Z-score (p-value = .028) in the first postsurgical SPECT-CT. These posterior cingulate changes represent a 4.83% increase in ratio and 91.04% in Z-Score (p-value = .035 and .040, respectively). Conclusion: CBP changes significantly in specific cortical areas after cranioplasty. Posterior cingulate changes might explain some improvements in attention impairments. SPECT-CT could be a useful tool to assess CBP changes in these patients and might be helpful in their clinical management.