DOI: https://doi.org/10.25305/unj.57745

Changes in сerebral hemodynamics in patients with severe traumatic brain injury after surgical decompression

Lyudmila Dzyak, Andriy Sirko, V. Suk, L. Kremenchutska

Abstract


A prospective study of 16 patients with severe TBI and traumatic brain edema who had undergone decompressive craniectomy (DC) with dura opening was carried out. Directly before surgical intervention and afterwards, TCDG was used to measure blood flow linear velocity (BFLV) in the middle cerebral artery (MCA) in both hemispheres and in extracranial segments of internal carotid artery (ICA). BFLV increase in MCA and ICA both on the side of surgery and the opposite side was determined. The difference between average BFLV growth in MCA on the side of decompression and the opposite side was statistically significant (P<0.05). MCA and ICA pulsatility index (PI), both on the side of surgery and the opposite side, decreased. PI decrease in MCA was significantly greater on the side of decompression than on the opposite side (P<0.05).


Keywords


severe traumatic brain injury; brain edema; decompressive craniectomy; intracranial hypertension; transcranial dopplerography; cerebral hemodynamics; pulsatility index; blood flow linear velocity

References


1. Gaydar BV, Semenyutin VB, Parfenov VYe, Svistov DV. Transkranialnaya dopplerografiya v neyrokhirurgii [Transcranial Doppler in Neurosurgery]. St. Petersburg: Elbi; 2008. Russian.

2. Bolyukh A. Tserebralnyy vazospazm v hostromu periodi travmatychnoho vnutrishnocherepnoho krovovylyvu [Cerebral vasospasm in acute traumatic intracranial hemorrhage] [dissertation]. Kiev (Ukraine): Romodanov Neurosurgery Institute; 2004. Ukrainian.

3. Morgalla MH, Will BE, Roser F, Tatagiba M. Do long-term results justify decompressive craniectomy after severe traumatic brain injury? J Neurosurg. 2008 Oct;109(4):685-90. [CrossRef] [PubMed]

4. Huang AP, Tu YK, Tsai YH, Chen YS, Hong WC, Yang CC, Kuo LT, Su IC, Huang SH, Huang SJ. Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion. J Neurotrauma. 2008 Nov;25(11):1347-54. [CrossRef] [PubMed]

5. Rinaldi A, Mangiola A, Anile C, Maira G, Amante P, Ferraresi A. Hemodynamic effects of decompressive craniectomy in cold induced brain oedema. Acta Neurochir Suppl (Wien). 1990;51:394-6. [PubMed]

6. Schaller B, Graf R, Sanada Y, Rosner G, Wienhard K, Heiss WD. Hemodynamic and metabolic effects of decompressive hemicraniectomy in normal brain. An experimental PET-study in cats. Brain Res. 2003 Aug 22;982(1):31-7. [CrossRef] [PubMed]

7. Yamakami I, Yamaura A. Effects of decompressive craniectomy on regional cerebral blood flow in severe head trauma patients. Neurol Med Chir (Tokyo). 1993 Sep;33(9):616-20. [CrossRef] [PubMed]

8. Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg. 1982 Dec;57(6):769-74. [CrossRef] [PubMed]

9. Gosling RG, King DH. Continuous wave ultrasound as an alternative and complement to X-rays in vascular examinations. In: Reneman RE, editor. Cardiovascular application of ultrasound. Amsterdam; 1974. p.266-82.

10. Martin NA, Patwardhan RV, Alexander MJ, Africk CZ, Lee JH, Shalmon E, Hovda DA, Becker DP. Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm. J Neurosurg. 1997 Jul;87(1):9-19. [CrossRef] [PubMed]

11. Stiefel MF, Heuer GG, Smith MJ, Bloom S, Maloney-Wilensky E, Gracias VH, Grady MS, LeRoux PD. Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg. 2004 Aug;101(2):241-7. [CrossRef] [PubMed]

12. Verweij BH, Muizelaar JP, Vinas FC. Hyperacute measurement of intracranial pressure, cerebral perfusion pressure, jugular venous oxygen saturation, and laser Doppler flowmetry, before and during removal of traumatic acute subdural hematoma. J Neurosurg. 2001;95(4):569-72. [CrossRef]

13. Schneider GH, Bardt T, Lanksch WR, Unterberg A. Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome. Acta Neurochir Suppl. 2002;81:77-9. [PubMed]

14. Hassler W, Steinmetz H, Gawlowski J. Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J Neurosurg. 1988 May;68(5):745-51. [PubMed]

15. Schmidt B, Czosnyka M, Raabe A, Yahya H, Schwarze JJ, Sackerer D, Sander D, Klingelhöfer J. Adaptive noninvasive assessment of intracranial pressure and cerebral autoregulation. Stroke. 2003 Jan;34(1):84-9. [CrossRef] [PubMed]

16. Juul N, Morris GF, Marshall SB, Marshall LF. Intracranial hypertension and cerebral perfusion pressure: influence on neurologicaldeterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg. 2000 Jan;92(1):1-6. [CrossRef] [PubMed]

17. Lee JH, Kelly DF, Oertel M, McArthur DL, Glenn TC, Vespa P, Boscardin WJ, Martin NA. Carbon dioxide reactivity, pressure autoregulation, and metabolic suppression reactivity after head injury: a transcranial Doppler study. J Neurosurg. 2001 Aug;95(2):222-32. [CrossRef] [PubMed]

18. Steiner LA, Czosnyka M. Should we measure cerebral blood flow in head-injured patients? Br J Neurosurg. 2002 Oct;16(5):429-39. [CrossRef] [PubMed]

19. Lang EW, Lagopoulos J, Griffith J, Yip K, Mudaliar Y, Mehdorn HM, Dorsch NW. Noninvasive cerebrovascular autoregulation assessment in traumatic brain injury: validation and utility. J Neurotrauma. 2003 Jan;20(1):69-75. [CrossRef] [PubMed]

20. Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD. Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery. 1997 Jul;41(1):11-9. [CrossRef] [PubMed]

21. Czosnyka M, Smielewski P, Piechnik S, Steiner LA, Pickard JD. Cerebral autoregulation following head injury. J Neurosurg. 2001 Nov;95(5):756-63. [CrossRef] [PubMed]


GOST Style Citations


1.  Транскраниальная допплерография в нейрохирургии / Б.В. Гайдар, В.Б. Семенютин, В.Е. Парфенов, Д.В. Свистов. — СПб.: Элби, 2008. — 281 с.

2.  Болюх А.С. Церебральний вазоспазм в гострому періоді травматичного внутрішньочерепного крововиливу: автореф. дис. на здобуття наук. ступеня канд. мед. наук: спец. 14.01.05 — нейрохірургія / А.С. Болюх; Ін-т нейрохірургії ім. акад. А.П. Ромоданова АМН України. — К., 2004. — 23 с.

3.  Do long-term results justify decompressive craniectomy after severe traumatic brain injury? / M.H. Morgalla, B.E. Will, F. Roser [et al.] // J. Neurosurg. — 2008. — V.109. — P.685–690.

4.  Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion / A.P. Huang, Y.K. Tu, Y.H. Tsai [et al.] // J. Neurotrauma. — 2008. — V.25. — P.1347–1354.

5.  Hemodynamic effects of decompressive craniectomy in cold induced brain oedema / A. Rinaldi, A. Mangiola, C. Anile [et al.] // Acta. Neurochir. — 1990. — V.51, suppl. — P.394–396.

6.  Hemodynamic and metabolic effects of decompressive hemicraniectomy in normal brain. An experimental PET-study in cats / B. Schaller, R. Graf, Y. Sanada [et al.] // Brain Res. — 2003. — V.982. — P.31–37.

7.  Yamakami I. Effects of decompressive craniectomy on regional cerebral blood flow in severe head trauma patients / I. Yamakami, A. Yamaura // Neurol. Med. Chir. — 1993. — V.33. — P.616–620.

8.  Aaslid R. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries / R. Aaslid, T.M. Markwalder, H.J. Nornes // Neurosurgery. — 1982. — V.57. — P.769–774.

9.  Gosling R.G. Continuous wave ultrasound as an alternative and complement to X-rays in vascular examinations / R.G. Gosling, D.H. King // Cardiovascular application of ultrasound; ed. R.E. Reneman. — Amsterdam, 1974. — P.266–282.

10.       Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia and vasospasm / N.A. Martin, R.V. Patwardhan, M.J. Alexander [et al.] // J. Neurosurg. — 1997. — V.87. — P.9–19.

11.       Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension / M.F. Stiefel, G.G. Heuer, M.J. Smith [et al.] // J. Neurosurg. — 2004. — V.101. — P.241–247.

12.       Verweij B.H. Hyperacute measurement of intracranial pressure, cerebral perfusion pressure, jugular venous oxygen saturation, and laser Doppler flowmetry, before and during removal of traumatic acute subdural hematoma / B.H. Verweij, J.P. Muizelaar, F.C. Vinas // J. Neurosurg. — 2001. — V.95. — P.569–572.

13.       Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome / G.H. Schneider, T. Bardt, W.R. Lanksch [et al.] // Acta Neurochir. — 2002. — V.81, suppl. — P.77–79.

14.       Hassler W. Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest / W. Hassler, H. Steinmetz, J. Gawlowski // J. Neurosurg. — 1988. — V.68. — P.745–751.

15.       Adaptive noninvasive assessment of intracranial pressure and cerebral autoregulation / B. Schmidt, M. Czosnyka, A. Raabe [et al.] // Stroke. — 2003. — V.34. — P.84–89.

16.       Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial / N. Juul, G.F. Morris, S.B. Marshall [et al.] // J. Neurosurg. — 2000. — V.92. — P.1–6.

17.       Carbon dioxide reactivity, pressure autoregulation, and metabolic suppression reactivity after head injury: a transcranial Doppler study / J.H. Lee, D.F. Kelly, M. Oertel [et al.] // J. Neurosurg. — 2001. — V.95. — P.222–232.

18.       Steiner L.A. Should we measure cerebral blood flow in head injured patients? / L.A. Steiner, M. Czosnyka // Br. J. Neurosurg. — 2002. — V.16. — P.429–439.

19.       Noninvasive cerebrovascular autoregulation assessment in traumatic brain injury: Validation and utility / E.W. Lang, J. Lagopoulos, J. Griffith [et al.] // J. Neurotrauma. — 2003. — V.20. — P.69–75.

20.       Continuous assessment of the cerebral vasomotor reactivity in head injury / M. Czosnyka, P. Smielewski, P. Kirkpatrick [et al.] // Neurosurgery. — 1997. — V.41. — P.11–19.

21.       Cerebral autoregulation following head injury / M. Czosnyka, P. Smielewski, S. Piechnik [et al.] // J. Neurosurg. — 2001. — V.95. — P.756–763.





Copyright (c) 2012 Lyudmila Dzyak, Andriy Sirko, V. Suk, L. Kremenchutska

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