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Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation
Edson Bor-Seng-Shu1, Marcelo de-Lima-Oliveira1, Ricardo Carvalho Nogueira1
1Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil.
Frontiers in Neurology
|April 30, 2019
Summary
Decompressive craniectomy (DC) in traumatic brain injury (TBI) patients shows diverse cerebral hemodynamic patterns. While effective for cerebral oligoemia, DC alone may be insufficient for optimal patient outcomes.
Area of Science:
- Neuroscience
- Neurosurgery
- Critical Care Medicine
Background:
- Cerebral hemodynamic patterns post-decompressive craniectomy (DC) for traumatic brain injury (TBI) are understudied.
- Understanding these patterns is crucial for guiding TBI treatment strategies.
Purpose of the Study:
- To investigate postoperative cerebral hemodynamic patterns in TBI patients after DC using transcranial Doppler (TCD) ultrasonography.
- To analyze the relationship between observed cerebral circulatory patterns and patient outcomes at 6 months.
Main Methods:
- Prospective study of 19 TBI patients with uncontrolled brain swelling undergoing DC.
- Cerebral blood circulation assessed via TCD ultrasonography.
- Correlation of TCD findings with neurological status, CT midline shift, and Glasgow Outcome Scale scores.
Main Results:
- Observed diverse hemodynamic patterns: oligoemia (5.3%), hyperemia (21%), vasospasm (15.8%), and mixed patterns.
- 47.4% of patients exhibited abnormal TCD-circulatory patterns.
- No significant association found between TCD findings and patient outcomes at 6 months.
Conclusions:
- Significant heterogeneity in postoperative cerebral hemodynamics exists among TBI patients post-DC, including inter-hemispheric differences.
- DC demonstrated efficacy in treating cerebral oligoemia.
- Findings suggest TBI pathophysiology is heterogeneous and DC as a sole treatment may be insufficient.
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