Skull vault defects reconstruction: comparison of different techniques and results and effect on cerebral hemodynamics: evaluation with transcranial Doppler sonography

ABSTRACT

The present study is a single-institution prospective clinical and radiological study conducted to evaluate the techniques and results of skull vault defects reconstruction and to investigate changes of cerebral hemodynamics after cranioplasty using transcranial Doppler sonography [TCDS]. All patients underwent clinical and radiological evaluation of their skull defects before and immediately after surgery and at least one year later. The cerebral hemodynamics was examined with TCDS pre-operatively and during the first month postoperatively. The average preoperative defect surface area measured 34 cm2 [range 6-110 cm2]. Skull defects were reconstructed using different methods of cranioplasty. Fifteen patients were repaired with fixed autogenous bone grafts [five cases with rib grafts, five cases with iliac grafts and five cases with split-thickness cranial bone grafts], five cases with acrylic, five cases with titanium mesh and five cases with high-density polyethylene implants [medpor implants]. Regarding follow-up, all patients were monitored a minimum of 12 months with a mean of 21 months. The results and complications were evaluated in relation to each technique. Changes in cerebral blood flow [CBF] were recorded. Before cranioplasty, all the velocities ipsilateral to the cranial defect were significantly low, while in the contralateral side they were near normal. Ipsilateral low cerebral blood flow increased and reached normal levels after cranioplasty. During the follow-up, neurological improvements was observed