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  • Neurophysiological Evaluation with TMS Before and After Cranioplasty: Correlation with Neuropsychological Visuoconstructive Scores

    Final Number:

    Gustavo Sousa Noleto MD; Fernanda Coelho; Cintya Hayashi; Davi Jorge Fontoura Solla; Nadia Nader Mangini PhD; Almir F. Andrade MD, PhD; Eberval Gadelha Figueiredo; Wellingson S. Paiva MD PhD; Manoel Jacobsen Teixeira

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Severe traumatic brain injury (TBI) or malignant hemispheric infarction (MHI) associated with refractory intracranial hypertension may require decompressive craniectomy to lower intracranial pressure, saving patient`s life. Large skull defects may cause impairment of neurological and cognitive functions. Some studies have shown functional benefits of cranioplasty like brain hemodynamics improvement. However, there are no information about cortical networks. It`s not understood why some patients have improvement in neurological functions after cranioplasty. We aim to evaluate neurophysiological findings through transcranial magnetic stimulation (TMS) and correlate with neuropsychologic evolution.

    Methods: 31 patients ( TBI or MHI treated with unilateral decompressive craniectomy) were evaluated with TMS before and after cranioplasty. Neuropsychological assessment was conducted using Rey Complex Figures (RCF) and Cube Tests. Short Interval Cortical Inibition (SICI) values were calculated using TMS. RCF test z scores and Cubes test percentiles were normally distributed; their results were analysed through repeated measures general linear models.

    Results: Mean age of patients was 41, 04 ± 15,2 years. Median time to surgery was 16.5 months; median score in Modified Rank Scale was 2. Preoperative SICI: 0,937 ± 0,709. Postoperative mean SICI: 0,881± 0,596, (p= 0,67). The findings of visuoconstructive tests are shown attached

    Conclusions: This is the first study that shows differences in cortical networks with cranioplasty. Despite not significant statistically, SICI values showed a tendency to reduction on postop evaluation. Our data suggests that cranioplasty may enhance neurophysiological recovery in a similar way to that seen on cerebrovascular aspects. It may provides, in the future, important information to understand the pathophysiology in these patients and may help to define which patients could have clinical improvement after cranioplasty.

    Patient Care: By improving understanding on pathophysiology of functional recovery after cranioplasty

    Learning Objectives: We aim to improve understanding on neurophysiological aspects in terms of cortical excitability after cranioplasty and correlate with clinical improvement


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