The Effect Of Cranioplasty To Neurological And Cognitive Function Of The Patient

ObjectiveMost of the skull defect caused by the open head injury, surgical decompression and intracranial tumor resection, congenital malformations, continual bone disorders and other disease , is the more common side effect of the brain surgery. The brain can be easily injured because of the losing of normal skull barrier, and skull defect can cause a variety of symptoms and effects of appearance. Generally if the skull defects smaller than 3 cm in diameter and the temporal and occipital muscle under the skull defect due to muscle and anadesma cover the skull defects in the formation of fibrous more tenacity played with skull-brain protection have no clinical symptoms, the rest often have clinical symptoms which need reconstruction. The defect which more than 3 cm in diameter, probably cause dizziness, headaches, depression, irritability, poor discipline and restlessness physical, psychological aspects of the symptoms; Large areas of the skull defect will cause serious cranium malformation and damage the physiological balance of intracranial pressure, atmospheric pressure of the long-term directly affect the brain tissue of the defect area can lead to the telatrophy of the brain, increasing symptoms of brain damage; The skull defects in children with developmental defect in turn, marginalized valgus, a prominent brain atrophy was conducted and cystic degeneration .Cranioplasty can avoid the recurrence of brain injury, can achieve the plastic effect ,also increase the brain blood flow, can improve the brain energy metabolism and promote the resumption of brain tissue, treat the enencephalocele skull defects patients with neurological cognition and mental syndrome. At present, there is no ideal technology and materials so that the skull defect from the shape, structure and function to be completely restored, engineering tissue especially the bone engineering tissue's emergence and development bring hope for ideals to the reality.At present, due to various reasons the skull defect repair is the main purpose for the protection of plastic and cranial contents needs. In clinical found that cranioplasty also can affect the neurological and cognitive function of the patients. Although in domestic there are some reports of the improvement of the effect of cranioplasty to neurological and moderate cognitive patients. But there are not analysis of the reason for the improvement of neurological and cognitive of the skull defect patients. This test summed up the clinical data of the cranioplasty patients of our hospital since July 2005 to January 2007 .Observing cranioplasty patient's neurolocal, cognitive and intracranial blood flow velocity changes before and after surgery, discuss the changes of neurological and cognitive function and analysis its reason.MethodsThere are 32 patients .27 of them are men ,the rest are women, the ages 13-65,average 31 years old. Two cases of autologous reconstruction skull defects, 30 cases of titanium mesh ,the skin flap should make full use of the original incision, if take a seperately incision, taking into account the influence of the original incision scar on the flap revascularization, prevent poor revascularization delayed wound healing; when decoherence skin Flap, should avoid emerging too thin scalp lead necrosis because of poor blood, also advised not to injury dura, in order to reduce the recurrence of cerebrospinal fluid leakage . The porous titanium mesh structure to facilitate drainage subcutaneous fluid and the epidural, after the organization grew into a riveting stationary, accelerate tissue healing. The peripheral of the bone defect need not repair, bone clothing need not open ,covering the metal titanium mesh to the defect, screw around. Titanium mesh implant in situ, that is, epidural temporalis muscle, the temporalis muscle will not be placed under the titanium mesh, to avoid the repeatedly movement of temporalis muscle cause pulling pain, fully exposed bone defects, the metal titanium mesh should be firmly fixed if it cover the skull defect. The large skull defect required a central thread fix the dura to metal titanium mesh to reduce dead space. Prevent postoperative hematoma and fluid, if needed subcutaneous hydrops should be punctured and compression bandaging. On the 2nd day before surgery and 10 days after surgery for patients with neurological and cognitive function evaluation, the evaluation of neurological function with NIHSS (National Institutes of Health Stroke Scale). Cognitive function using MMSE (mini-mental state examination). On the 2d pre-operative and 10d post-operative days via transcranial Doppler ultrasound (TCD) to detection intracranial blood flow.Results1. Thirty patients with titanium mesh for the cranioplasty with only one occurred subcutaneous fluid after surgery, and one patient had epilepsy. Some titanium mesh molding with computer, and the patient satisfacty with the repair effects, have fewer complications. 2 patients use autologous bone flap for cranioplasty, the skull flaps are preserved through medical alcohol, there was no skull flap subsidence and other significant complications.2. After cranioplasty, cognitive function of the patients showed a significant improvement compare with preoperative evaluation (P<0.05)3. After cranioplasty, neurological function of the patients showed a significant improvement compare with preoperative evaluation (P<0.05)4. Before Cranioplasty ,the blood flow of the injuried side lower than the uninjuried side ,the blood flow of the two side not at the same level(P<0.05).After cranioplasty , the blood flow of the injuried side have a significant increase(P<0.05), the blood flow of the two side are at the same level with.Conclusion1. Cranioplasty can significantly improve the cognitive function of the patients. 2. Cranioplasty can significantly improve the neurological function of the patients.3. Canioplasty can increase the brain blood flow of the injuried side, this can partly explain the improvement of cranioplasty to neurological and cognitive function of the patients.