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Functional improvements associated with cranioplasty after stroke and traumatic brain injury: a cohort study

Published online by Cambridge University Press:  17 November 2023

F. Coelho ,
G.S. Noleto Open the ORCID record for G.S. Noleto [Opens in a new window] ,
D.J.F. Solla ,
P.N. Martins Open the ORCID record for P.N. Martins [Opens in a new window] ,
A.F. Andrade ,
M.J. Teixeira ,
W.S. Paiva  and
R. Anghinah
F. Coelho
Affiliation:
Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
G.S. Noleto*
Affiliation:
Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
D.J.F. Solla
Affiliation:
Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
P.N. Martins
Affiliation:
Faculty of Medicine, Juiz de Fora Medical School, Juiz DE Fora, Brazil
A.F. Andrade
Affiliation:
Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
M.J. Teixeira
Affiliation:
Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
W.S. Paiva
Affiliation:
Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
R. Anghinah
Affiliation:
Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
*
*Corresponding author. Email: gustavosnoleto@yahoo.com.br
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Abstract

Objective:

Decompressive craniectomy is part of the acute management of several neurosurgical illnesses, and is commonly followed by cranioplasty. Data are still scarce on the functional and cognitive outcomes following cranioplasty. We aim to evaluate these outcomes in patients who underwent cranioplasty following traumatic brain injury (TBI) or stroke.

Methods:

In this prospective cohort, we assessed 1-month and 6-month neuropsychological and functional outcomes in TBI and stroke patients who underwent cranioplasty at a Brazilian tertiary center. The primary outcome was the change in the Digits Test at 1 and 6 months after cranioplasty. Repeated measures general linear models were employed to assess the patients' evolution and interactions with baseline characteristics. Effect size was estimated by the partial η2.

Results:

A total of 20 TBI and 14 stroke patients were included (mean age 42 ± 14 years; 52.9% male; average schooling 9.5 ± 3.8 years; 91.2% right-handed). We found significant improvements in the Digits Tests up to 6 months after cranioplasty (p = 0.004, partial η2 = 0.183), as well as in attention, episodic memory, verbal fluency, working memory, inhibitory control, visuoconstructive and visuospatial abilities (partial η2 0.106–0.305). We found no interaction between the cranioplasty effect and age, sex or schooling. Patients submitted to cranioplasty earlier (<1 year) after injury had better outcomes.

Conclusion:

Cognitive and functional outcomes improved after cranioplasty following decompressive craniectomy for stroke or TBI. This effect was consistent regardless of age, sex, or education level and persisted after 6 months. Some degree of spontaneous improvement might have contributed to the results.

Keywords

Decompressive craniectomycognitionbrain injuriestraumaticcerebrovascular diseasestrokeneuropsychological tests
Type
Original Article
Information
Brain Impairment , Volume 24 , Issue 3 , December 2023 , pp. 721 - 731
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment

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