Bor-Seng-Shu Edson, Paiva Wellingson Silva, Figueiredo Eberval G, Fujimoto Yasunori, de Andrade Almir Ferreira, Fonoff Erich Talamoni, Teixeira Manoel Jacobsen
Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo, School of Medicine, 255 Eneas Aguiar Street, Office 4079, 05403010 Sao Paulo, SP, Brazil.
Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Biomed Res Int. 2013;2013:750809. doi: 10.1155/2013/750809. Epub 2013 Nov 27.
The pathophysiology of traumatic brain swelling remains little understood. An improved understanding of intracranial circulatory process related to brain herniation may have treatment implications.
To investigate the cerebral hemodynamic changes associated with brain herniation syndrome due to traumatic brain swelling.
Nineteen head-injured patients with evidence of refractory intracranial hypertension and transtentorial herniation were prospectively studied. Cerebral hemodynamic assessment by transcranial Doppler (TCD) ultrasonography was performed prior to decompressive craniectomy. Patients and their cerebral hemispheres were classified according to TCD-hemodynamic patterns, and the data correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury.
A wide variety of cerebral hemodynamic findings were observed. Ten patients (52.7%) presented with cerebral oligoemia, 3 patients (15.8%) with cerebral hyperemia, and 6 patients with nonspecific circulatory pattern. Circulatory disturbances were more frequently found in the side of maximal cerebral swelling than in the opposite side. Pulsatility index (PI) values suggested that ICP varied from acceptable to considerably high; patients with increased PI, indicating higher microvascular resistance. No correlation was found between cerebral hemodynamic findings and outcome.
There is a marked heterogeneity of cerebral hemodynamic disturbances among patients with brain herniation syndrome.
创伤性脑肿胀的病理生理学仍知之甚少。更好地理解与脑疝相关的颅内循环过程可能对治疗有指导意义。
研究创伤性脑肿胀所致脑疝综合征相关的脑血流动力学变化。
前瞻性研究19例有难治性颅内高压和经天幕疝证据的颅脑损伤患者。在减压性颅骨切除术前，采用经颅多普勒（TCD）超声进行脑血流动力学评估。根据TCD血流动力学模式对患者及其大脑半球进行分类，并将数据与神经功能状态、CT扫描中线移位以及伤后6个月的格拉斯哥预后评分相关联。
观察到多种脑血流动力学表现。10例患者（52.7%）表现为脑供血不足，3例患者（15.8%）表现为脑充血，6例患者表现为非特异性循环模式。循环障碍在脑肿胀最严重的一侧比在对侧更常见。搏动指数（PI）值表明颅内压从可接受水平到相当高的水平不等；PI升高的患者表明微血管阻力更高。脑血流动力学表现与预后之间未发现相关性。
脑疝综合征患者的脑血流动力学障碍存在明显异质性。
