Bor-Seng-Shu Edson, Teixeira Manoel Jacobsen, Hirsch Roberto, Andrade Almir Ferreira de, Marino Raul
Division of Neurosurgery, Hospital das Clínicas, São Paulo University Medical School, São Paulo, SP, Brazil.
Arq Neuropsiquiatr. 2004 Sep;62(3A):715-21. doi: 10.1590/s0004-282x2004000400028. Epub 2004 Aug 24.
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.
减压性颅骨切除术在治疗严重创伤后脑肿胀中的作用仍然是一个颇具争议的问题。据我们所知，尚无研究通过经颅多普勒超声（TCD）来证明减压性颅骨切除术对脑血流（CBF）速度的影响。我们报告了两名发生创伤性脑肿胀且伴有昏迷和小脑幕切迹疝体征的颅内高压无法控制的患者。一名患者接受了双额叶减压性颅骨切除术，而另一名患者接受了单侧额颞顶减压性颅骨切除术并进行了硬脑膜扩张。在这两名患者中，术前和术后均立即进行了TCD检查，以研究与手术相关的脑血流动力学变化。术前和术后的TCD检查均显示，两名患者颅内动脉的血流速度均显著增加。总之，我们的病例表明，伴有硬脑膜扩张的减压性颅骨切除术可能会使大面积脑肿胀患者的CBF速度升高。CBF速度的增加似乎不仅发生在减压侧半球，也发生在对侧。
