scholarly journals Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases

2004 ◽  
Vol 62 (3a) ◽  
pp. 715-721 ◽  
Author(s):  
Edson Bor-Seng-Shu ◽  
Manoel Jacobsen Teixeira ◽  
Roberto Hirsch ◽  
Almir Ferreira de Andrade ◽  
Raul Marino Jr
Keyword(s):  
Blood Flow ◽  
Decompressive Craniectomy ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Brain Swelling ◽  
Hemodynamic Changes ◽  
Before And After ◽  
Intracranial Arteries

The role of decompressive craniectomy in the treatment of severe posttraumatic cerebral swelling remains quite a controversial issue. To the best of our knowledge, there is no study demonstrating the effect of decompressive craniectomy on cerebral blood flow (CBF) velocity by means of transcranial Doppler sonography (TCD). We present two patients who developed traumatic brain swelling and uncontrollable intracranial hypertension with coma and signs of transtentorial herniation. One patient underwent bifrontal, while the second, unilateral, frontotemporoparietal decompressive craniectomy with dural expansion. In both patients, TCD examinations were performed immediately before and after surgery to study the cerebral hemodynamic changes related to the operations. Pre and postoperative TCD examinations demonstrated a significant increase in blood flow velocity in the intracranial arteries in both subjects. In conclusion, our cases suggest that decompressive craniectomy with dural expansion may result in elevation of CBF velocity in patients with massive brain swelling. The increase in CBF velocity appears to occur not only in the decompressed hemisphere, but also on the opposite side.

TRANSCRANIAL DOPPLER SONOGRAPHY IN CORRELATION TO 3D CT Xe CEREBRAL BLOOD FLOW

1992 ◽  
Vol 77 (Supplement) ◽  
pp. A165
Author(s):  
P. Brauer ◽  
W. A. Kofke ◽  
C. Werner ◽  
E. Kochs ◽  
M. Bloom ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
3D Ct

Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression

2006 ◽  
Vol 104 (1) ◽  
pp. 93-100 ◽  
Author(s):  
Edson Bor-Seng-Shu ◽  
Roberto Hirsch ◽  
Manoel Jacobsen Teixeira ◽  
Almir Ferreira de Andrade ◽  
Raul Marino
Keyword(s):  
Decompressive Craniectomy ◽  
Transcranial Doppler ◽  
Neurological Outcome ◽  
Contralateral Side ◽  
Surgical Decompression ◽  
Brain Swelling ◽  
Hemodynamic Changes ◽  
Cerebral Hemodynamic ◽  
The Mean ◽  
Extracranial Ica

Object The use of decompressive craniectomy has experienced a revival in the previous decade, although its actual benefit on patients’ neurological outcome remains the subject of debate. A better understanding of the intracranial pressure dynamics, as well as of the metabolic and hemodynamic brain processes, may be useful in assessing the effect of this surgery on the pathophysiology of the swollen brain. The aim of this study was to use transcranial Doppler (TCD) ultrasonography to examine the hemodynamic changes in the brain after decompressive craniectomy in patients with head injury, in addition to examining the relationship between such hemodynamic changes and the patient’s neurological outcome. Methods Nineteen patients presenting with traumatic brain swelling and cerebral herniation syndrome who had undergone decompressive craniectomy with dural expansion were studied prospectively. The TCD ultrasonography measurements were performed bilaterally in both the middle cerebral artery (MCA) and in the distal portion of the cervical internal carotid artery (ICA) immediately prior to and after surgical decompression. After surgery, the mean blood flow velocity (BFV) rose to 175 ± 209% of preoperative values in the MCA of the operated side, while rising to 132 ± 183% in the contralateral side; the difference between the mean BFV increase in in the MCA of both the decompressed and the opposite side reached statistical significance (p < 0.05). The mean BFV of the extracranial ICA increased to 91 ± 119% in the surgical side and 45 ± 60% in the opposite side. Conversely, the MCA pulsatility index (PI) values decreased, on average, to 33 ± 36% of the preoperative value in the operated side and to 30 ± 34% on the opposite side; the MCA PI value reductions were significantly greater in the decompressed side when compared with the contralateral side (p < 0.05). The PI of the extracranial ICA reduced, on average, to 37 ± 23% of the initial values in the operated side and to 24 ± 34%, contralaterally. No correlation was verified between the neurological outcome and cerebral hemodynamic changes seen on TCD ultrasonography. Conclusions Decompressive craniectomy results in a significant elevation of cerebral BFV in most patients with traumatic brain swelling and transtentorial herniation syndrome. The increase in cerebral BFV may also occur in the side opposite the decompressed hemisphere; the cerebral BFV increase is significantly greater in the operated hemisphere than contralaterally. Concomitantly, PI values decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance.

Relative Changes in Cerebral Blood Flow During Cardiac Operations Using Xenon-133 Clearance Versus Transcranial Doppler Sonography

1997 ◽  
Vol 63 (1) ◽  
pp. 167-174 ◽  
Author(s):  
Uday H Trivedi, FRCS ◽  
Ramesh L Patel, FRCS(Ed) ◽  
Mark R.J Turtle, PGDip ◽  
Graham E Venn, FRCS ◽  
David J Chambers, PhD
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Xenon 133 ◽  
Cardiac Operations
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