The influence of decompressive craniectomy for XXXX on early cerebral perfusion.

@entity1 @entity4 @entity64
UNASSIGNED: OBJECT Multiple trials have shown improved survival and functional outcome in @entity1 treated with decompressive craniectomy (DC) for @entity4 following @entity64 . It has been assumed that decompression induces an improvement in cerebral perfusion. This observational study directly measured cerebral perfusion before and after decompression. METHODS Sixteen @entity1 were prospectively examined with perfusion CT within 6 hours prior to surgery and 12 hours after surgery. Preoperative and postoperative perfusion measurements were compared and correlated. RESULTS Following DC there was a significant increase in cerebral blood flow in all measured territories and additionally an increase in cerebral blood volume in the penumbra (p = 0.03). These changes spread as far as the contralateral hemisphere. No significant changes in mean transit time or Tmax (time-to-peak residue function) were observed. CONCLUSIONS The presurgical perfusion abnormalities likely reflected local pressure-induced hypoperfusion with impaired autoregulation. The improvement in perfusion after decompression implied an increase in perfusion pressure, likely linked to partial restoration of autoregulation. The increase in perfusion that was observed might partially be responsible for improved clinical outcome following decompressive surgery for @entity64 . The predictive value of perfusion CT on outcome needs to be evaluated in larger trials.
