Effects of Early Skull Repair With Titanium Mesh on Cerebral Blood Flow and Neurological Recovery
Effects of Early Skull Repair With Titanium Mesh on Cerebral Blood Flow and Neurological Recovery
To evaluate the feasibility of CT perfusion technique to monitor the changes of blood
 perfusion in the brain tissue before and after skull repair using titanium mesh. To determine
 the best timing for skull repair using the three-dimensional titanium mesh; to compare the
 effects of early (1-3 months after decompression) and late-stage (6-12 months after
 decompression) skull repair on neurologic rehabilitation.
A skull defect is inevitable in patients with traumatic brain injury undergoing decompression
 treatment, which results in a loss of physiological and functional integrity of the brain
 that makes atmospheric pressure directly act on the brain tissue to induce environmental
 disorders in the brain. Moreover, with the changes in the body position, the contents of the
 brain often move in an unstable position, and with the extension of time, there may be
 compensatory ventricular enlargement and brain atrophy, eventually causing neurological
 dysfunction and cognitive disorders. Therefore, it is imperative to repair the skull defect.

 There are many repair materials for skull defects, including autogenous bone, allogeneic
 bone, nonmetallic materials (plexiglass, bone cement, silicone rubber, etc.) and titanium
 mesh. The performance of different materials have their own advantages and disadvantages, and
 titanium alloy is an ideal repair material and has been widely used in clinical practice
 because of good biocompatibility and strength, no aging, low density, non-iron atoms, ability
 to be not magnetized in magnetic fields, and no influence on CT, MRI, EEG and X-ray
 examination.

 The timing for repair of skull defect after traumatic brain injury is still controversial.
 Some scholars believe that if there is no hydrocephalus and intracranial infection after
 decompression with removal of bone flap, skull repair should be proceeded as soon as possible
 to isolate the scalp from the dura mater and recover the normal intracranial pressure by
 easing the negative effects of the scalp, such as cerebrovascular traction, compression and
 distortions. Most importantly, early skull repair is able to reduce a variety of secondary
 neurological deficits due to skull defects, increase brain surface blood flow, and thus
 reduce epileptic attack. Of course, some scholars recommend late-stage skull repair, and they
 believe hematoma absorption after decompressive surgery is a long process, and in some
 patients, hematoma will be completely absorbed in about 3 months or even longer, which may
 result in secondary brain edema. Moreover, surgical trauma exerts negative effect on the
 brain tissue recovery, which is not conducive to neurologic rehabilitation.

 As there is no unified conclusion on the timing for the repair of skull defects,
 investigators conducted a multi-sample, double-blind, randomized, clinical trial, to collect
 craniocerebral injury patients undergoing decompression with removal of bone graft who were
 randomized into two groups to receive early skull repair in test group and late-stage skull
 repair in control group. CT perfusion technology was used to monitor the blood perfusion in
 the brain before and after skull repair and to compare the changes of blood perfusion in the
 brain tissue and neurological recovery in patients undergoing early or late-stage skull
 repair.
Inclusion Criteria:

 -  Patients underwent decompression via removal of bone flap in the unilateral frontal
 temporal lobe due to craniocerebral injury and developed no postoperative infection.

 -  Patients agreed to receive skull repair using titanium mesh.

 -  Patients and their families agreed to receive CT perfusion examination.

 -  Patients and their families fully understood the study protocol and agreed to
 participate in the trial, and then singed the informed consent before the trial.

 Exclusion Criteria:

 -  Hypertension and diabetes out of control, severe heart disease, brain tumors, brain
 abscess, and cerebral infarction

 -  Diseases that have interfered with localized perfusion data, such as intracranial
 aneurysms, arteriovenous malformations

 -  Combined with depressed skull fractures and skull base fractures

 -  Hydrocephalus