Neurological improvement after cranioplasty - analysis by transcranial doppler ultrasonography

Cranioplasty can improve neurological status in patients with skull bone defects. The mechanism of postoperative improvement in neurologic status might be increased cerebral blood flow (CBF) velocity due to elimination of the effects of atmospheric pressure. Between May 2001 and June 2002, 13 patients (8 men and 5 women; average age, 46 years; range, 21-65 years) were studied. Postoperative changes in neurological status and blood flow velocity were examined and compared using transcranial Doppler (TCD) sonography. The mean interval between craniectomy and cranioplasty was 122.3+/-100.4 days. The mean interval between cranioplasty and performance of TCD examination was 15.2+/-2.8 days. The results showed significant improvements after cranioplasty in GCS, arm muscle power, and Barthel Index. While the CBF velocities tended to increase after cranioplasty, only the increase in the non-lesion side middle cerebral artery (MCA) was statistically significant. The interval from decompressive craniectomy to cranioplasty and neurological status change before and after cranioplasty was significantly negatively correlated. We conclude that cranioplasty can improve neurological status, and it should be performed as earlier as edema has resolved.