RELATIONSHIP BETWEEN CRANIAL DEFECT AND PHYSIOLOGY OF CEREBROSPINAL FLUID: An experimental study in - PowerPoint PPT Presentation

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RELATIONSHIP BETWEEN CRANIAL DEFECT AND PHYSIOLOGY OF CEREBROSPINAL FLUID: An experimental study in

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The aim of this study is to determine the effect of craniectomy on ... S. A case of traumatic hydrocephalus after large craniectomy for acute subdural hematoma. ... – PowerPoint PPT presentation

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Title: RELATIONSHIP BETWEEN CRANIAL DEFECT AND PHYSIOLOGY OF CEREBROSPINAL FLUID: An experimental study in


1
RELATIONSHIP BETWEEN CRANIALDEFECT AND
PHYSIOLOGY OF CEREBROSPINAL FLUID An
experimental study inrabbits
  • Dr. Ersin Erdogan
  • Department of Neurosurgery Gulhane
  • Military Medical School
  • Ankara, TURKEY

2
Objective
  • The aim of this study is to determine the effect
    of craniectomy on the flow kinetics of CSF, in
    vivo.

3
Introduction
  • Decompressive craniectomy performed
  • to reduce the increased intracranial pressure
    due to different etiological factors,
  • may cause clinical findings which called Sinking
    skin flap or trephined syndrome
  • Mizumaki Y, Oka N, Itoh K, Endo S. A case of
    traumatic hydrocephalus after large craniectomy
    for acute subdural hematoma. No Shinkei Geka
    200331201-206

4
Introduction
  • When cranioplasty had been applied to the cases
    of craniectomy, the objective and subjective
    improvements in clinical, cognitive and
    physiological findings were observed.
  • Erdogan E, Duz B, Kocaoglu M, Izci Y, Sirin S,
    Timurkaynak E. The effect of cranioplasty on
    cerebral hemodynamics evaluation with
    transcranial Doppler sonography. Neurol India.
    2003 Dec51(4)479-81.

5
Material and Methods
  • The experiments were conducted using eleven male
    New Zealand white rabbits weighing between 1500
    and 1800 g
  • The rabbits were anesthetized with a combination
    of ketamine and xylazine

6
cisternography with 30050 microcurie/0.1 cc
Tc-99m-diethylenetriamine pentaacetic acid
(Tc-99m-DTPA) injected into the 4th ventricle of
the rabbits via insulin injector.
Kusumi and
Plouffe 1979
7
Scanning
The rabbit was positioned laterally, with the
lateral cranial surface facing the detector of
the gamma camera
8
(Rabbit 3) The control cisternography of the
rabbit performed at the 3rd month
postoperatively. The reframed 1 hour follow-up
image.
9
Scanning
  • Dynamic data acquisition in every minute for a
    period of one hour was performed
  • Data were generated over the subsequent 60-minute
    at 60 second per frame in a dynamic mode after
    regions of interest were placed around the
    injection site.

10
Scanning
  • The computer-generated time activity curve for
    region of interest by using commercially
    available software (Entegra). Using data
    clearance half time (t 1/2) for each region of
    interest was generated in seconds using an
    exponential fit.
  • The t 1/2 values of pharmaceutical agent for each
    study were calculated with the same method and
    the results were recorded.

11
Surgery
  • After the preoperative cisternography, all
    rabbits were anesthetized The scalp was shaved,
    prepped with Betadine, and a midline scalp
    incision was made.
  • The periosteum was reflected laterally and a
    craniectomy was performed with microscopic
    magnification. The dura was exposed overlying
    right cerebral hemisphere and the scalp was then
    closed.
  • The mean width of cranial defect was 1/3 of
    hemicranium.

12
Statistical analysis
  • Differences in DTPA clearance t 1/2 before and
    after craniectomy were compared using the
    Wilcoxon Signed Ranks test.

13
Results
  • Four rabbits died in the 7th day of the
    experiment and a total of 5 rabbits died at the
    end of 3rd month and they were excluded from this
    study. The t 1/2 values and median (mean
    minimum-maximum) t 1/2 values obtained
    preoperatively, 24th hour, 7th day and 3rd month
    postoperatively are summarized in Table.

14
Statistically significant difference was not
found between these results according to Wilcoxon
Signed Ranks test.
15
The exponential fit applied-time/activity curve
obtained from the region of interest drawn on
the site of injection.
16
Conclusion
  • There is no doubt that the physiology of CSF is
    being influenced by cranial defect.
  • The most important evidence of this situation is
    variations of CSF pressure.
  • This pathophysiological change of CSF due to
    cranial defect is not clear, but it could be
    related to overproduction or decreased absorption
    of CSF that may increase pressure.

17
Conclusion
  • Our study is the first experimental study, which
    investigated the physiology of CSF kinetics via
    cisternography by protecting in vivo conditions.
  • Certainly, we stated that cranial defect do not
    cause statistically significant difference on the
    CSF kinetics.

18
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