Comprehensive cognitive and cerebral hemodynamic evaluation after cranioplasty

Figures & data

Figure 1 Computed tomography perfusion with four regions of interest selected in each cerebral hemisphere.

Note: Three superficial regions and one positioned in the basal ganglia.
Abbreviations: R, right; P, posterior.

Table 2 Summary of case series reported

Reference	Number of patients	TS symptoms improvement	Motor improvement	Aphasia improvement	Hemineglect improvement	Cognitive improvement	Functional evaluation
Grant and Norcross^Citation12	83 (43 with TS)	11 (25%)	6 (14%)	–	–	3 (7%) unspecified	–
Grantham and Landis^Citation15	100 (54 with TS)	16 (29%)	–	Referred but not quantified	–	–	–
Tabaddor and LaMorgese^Citation16	Case report	–	Positive	–	–	–	Dynamic brain scan
Yamaura and Makino^Citation13	33 (29 with TS)	–	9 (31%)	–	–	–	CSF pressure and EEG
Nakamura et al^Citation34	Case report	Positive	Positive	Positive	–	–	EEG
Fodstad et al^Citation20	40	22 (55%)	–	–	–	–	CSF infusion test
Richaud et al^Citation27	40 (15 with TS)	–	8 (53%)	1 (6%)	–	–	Xe133 inhalation
Segal et al^Citation22	Case report	–	Positive	–	–	–	–
Ng and Dan^Citation35	Case report	–	Positive	–	–	–	–
Schiffer et al^Citation36	5	Headache improvement in one case	4 (80%)	–	–	–	–
Winkler et al^Citation24	13	–	7 (53%)	2 (15%)	2 (15%)	7 (53%) unspecified	PET and TCD
Gottlob et al^Citation43	Case report	Positive	Positive	–	–	Positive, unspecified	–
Erdogan et al^Citation33	18	14 (77%)	5 (27%)	–	–	–	TCD
Sugiyama et al^Citation44	Case report	Positive	Positive		Positive	Positive	SPECT
Kuo et al^Citation23	13	–	8 (61%)	–	–	–	TCD
Isago et al^Citation25	Case report	Positive	Positive	Positive	–	–	Xenon CT
Kumar et al^Citation37	Case report	–	Positive	–	–	–	–
Maeshima et al^Citation26	Case report	–	–	–	Present	Positive, unspecified	SPECT
Sakamoto et al^Citation29	Case report	–	Positive	–	–	–	Perfusion CT
Chieregato^Citation38	Case report	Positive	Positive	Positive	–	–	–
Bijlenga et al^Citation42	Case report	Positive	Positive (tremor)	–	–	–	Brainstem evoked potential
Han et al^Citation39	Case report	–	–	–	–	Positive, unspecified	–
Stiver et al^Citation14	38	–	10 (26%)	–	–	–	Perfusion CT (two cases)
Joseph and Reilly^Citation40	Case report	–	Positive	–	–	–	–
Kemmling et al^Citation30	Case report	–	Positive	–	–	–	MR perfusion
Sarov et al^Citation41	27 (7 with TS)	3 (11%)	1 (3%)	–	–	–	–
Mokri^Citation49	Case report	Positive	Positive	–	–	Positive	–
de Quintana-Schmidt et al^Citation50	Case report	Positive	Positive	Positive	–	–	–
Carota et al^Citation51	Case report	–	–	–	–	Positive	–

Abbreviations: CSF, cerebrospinal fluid; CT, computed tomography; EEG, electroencephalography; PET, positron emission tomography; SPECT, single-photon emission computed tomography; TCD, transcranial Doppler ultrasonography; TS, trephine syndrome.

Figure 2 Cranial computed tomography before performing cranioplasty.

Note: We observed a significant depression of the skin flap with erasing wrinkles and superficial cortical compression.

Table 1 Neuropsychological assessment before and 6 months after cranioplasty

Tests	Results (preoperative)	Results (postoperative)
Neuropsychological assessment
WMS – Logical Memory II (immediate)	13; below average	24; below average
WMS – Logical Memory II (delayed)	8; below average	11; below average
WMS – VR (immediate)	1; below average	1; below average
WMS – VR (delayed)	1; below average	1; below average
RAVLT
(I)	2	2
(II)	3	4
(III)	9	10
(IV)	7	10
(V)	7 (below average)	12 (below average)
(B list)	5	1
(VI)	4	6
(VII)	4 (4.1; below average)	8 (2.3; below average)
FAS-test	23 (1.6; below average)	41 (0; average)
Verbal fluency	13 (1.8; below average)	17 (0.9; below average)
Digit span forward	8; below average	5; below average
Digit span backward	5; below average	4; below average
TMTA	0; not completed	3.1; below average
TMTB	0; not completed	9; below average
Arithmetics	6; below average	6; below average
Sequencing	6; below average	2; below average
Stroop test I	3; below average	4; below average
Stroop test II	6; below average	5; below average
Stroop test III	1.3; below average	0.1; below average
WMI-WAIS	25; average	11; below average
Cube copy test	8; below average	16; average
Complex rey figurea	3.16; below average	1.1; average
ISSLb	10/7/10	2/4/4
BDI	17; mild	5; minimal
BAI	12; mild	8; minimal
BHS	0; minimal	0; minimal
POD	0; minimal	0; minimal

Notes:

a The preoperative score was 3.16 times the standard deviation below the average of the expected score. The postoperative score was 1.1 time the standard deviation below the expected normal score, considering the average for this test.

b Values shown are psychological symptoms/physical symptoms/psychological and physical symptoms.

Abbreviations: BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; BHS, Beck Hopelessness Scale; FAS-Test, Controlled Oral Word Association Test (COWAT) – FAS Test; ISSL, Lipp Inventory of Stress Symptoms; POD, Pfeffer Outpatient Disability Scale; RAVLT, Ray Auditory Verbal Learning Test; TMTA, Trail Making Test Version A; TMTB, Trail Making Test Version B; VR, visual reproduction; WMI-WAIS, Working Memory Index from the Wechsler Adult Intelligence Scale; WMS, Wechsler Memory Scale.

Figure 3 Perfusion computed tomography before (top) and after (bottom) surgery showing the changes in the three parameters: CBF, CBV, and MTT.

Note: In this image we can also see a restructuring of the cortical mantle of the left frontal region.
Abbreviations: CBF, cerebral blood flow; CBV, cerebral blood volume; MTT, mean transit time.

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