Neurological Improvement after Cranioplasty in Patients with Surgical Bony Defects : The Usefulness of Acetazolamide Activated (99m)Tc-HMPAO SPECT.

Seo, Won Duck; Kim, Young Don; Hong, Dae Young; Kim, Dae Hyun; Choi, Gi Hwan; Yeo, Hyung Tae

Original Article

Journal of Korean Neurosurgical Society 2006;40(6): 434-440.

Won Duck Seo, Young Don Kim, Dae Young Hong, Dae Hyun Kim, Gi Hwan Choi, Hyung Tae Yeo

Department of Neurosurgery, Daegu Catholic University School of Medicine, Daegu, Korea. shydshyd@cu.ac.kr

ABSTRACT

OBJECTIVE
The purpose of this study is to examine the influence of cranioplasty on dynamics of cerebral blood flow(CBF) and cerebrovascular reserve capacity(CVRC), and to investigate the usefulness of single photon emission computed tomography (SPECT) as a prognostic factor for neurological improvement after cranioplasty.
METHODS
Between March 2003 and December 2005, a prospective study was performed on 24 patients who had undergone total 25 cranioplasty operations. Cerebral blood flow velocities in the middle cerebral artery(MCA) and internal carotid artery (ICA) were obtained by transcranial Doppler ultrasonography(TCD). The CVRC was assessed by SPECT in the natural state and after stimulation with 1g of acetazolamide. Neurological improvement after cranioplasty was compared between patients who showed hyperactivity to acetazolamide-activated SPECT (Group 1, n=7) and hypoactivity to acetazolamide-activated SPECT (Group 2, n=17). These measurements were obtained two weeks prior to and two weeks after cranioplasty.
RESULTS
The blood flow velocities at the opposite site to the cranioplasty as well as at the cranioplasty site were significantly increased (P<0.05). Compared with Group 2, there was significant increase in CBF and neurological imrovement after cranioplasty in Group 1.
CONCLUSION
Among patients with surgical bony defects, the patients who had normal reactivity of the CVRC showed a significant increase in CBF and neurological improvement after cranioplasty. The authors suggest that CVRC measurement prior to surgery may be an important prognostic factor for neurological improvement after cranioplasty.

Key Words: Cranioplasty; Cerebral blood flow(CBF); Cerebrovascular reserve capacity(CVRC); Transcranial Doppler ultrasonography(TCD); Acetazolamide Activated (99m)Tc-HMPAO SPECT