Bor-Seng-Shu Edson, de-Lima-Oliveira Marcelo, Nogueira Ricardo Carvalho, Almeida Kelson James, Paschoal Eric Homero Albuquerque, Paschoal Fernando Mendes
Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil.
Department of Neurology, Federal University of Piauí Medical School, Teresina, Brazil.
Front Neurol. 2019 Apr 12;10:354. doi: 10.3389/fneur.2019.00354. eCollection 2019.
There are no studies describing the cerebral hemodynamic patterns that can occur in traumatic brain injury (TBI) patients following decompressive craniectomy (DC). Such data have potentially clinical importance for guiding the treatment. The objective of this study was to investigate the postoperative cerebral hemodynamic patterns, using transcranial Doppler (TCD) ultrasonography, in patients who underwent DC. The relationship between the cerebral circulatory patterns and the patients' outcome was also analyzed. Nineteen TBI patients with uncontrolled brain swelling were prospectively studied. Cerebral blood circulation was evaluated by TCD ultrasonography. Patients and their cerebral hemispheres were categorized based on TCD-hemodynamic patterns. The data were correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Different cerebral hemodynamic patterns were observed. One patient (5.3%) presented with cerebral oligoemia, 4 patients (21%) with cerebral hyperemia, and 3 patients (15.8%) with cerebral vasospasm. One patient (5.3%) had hyperemia in one cerebral hemisphere and vasospasm in the other hemisphere. Ten patients (52.6%) had nonspecific circulatory pattern. Abnormal TCD-circulatory patterns were found in 9 patients (47.4%). There was no association between TCD-cerebral hemodynamic findings and outcome. There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient.
目前尚无研究描述减压性颅骨切除术（DC）后创伤性脑损伤（TBI）患者可能出现的脑血流动力学模式。此类数据对于指导治疗可能具有临床重要性。本研究的目的是使用经颅多普勒（TCD）超声检查来研究接受DC治疗的患者术后的脑血流动力学模式。还分析了脑循环模式与患者预后之间的关系。对19例脑肿胀无法控制的TBI患者进行了前瞻性研究。通过TCD超声评估脑血液循环。根据TCD血流动力学模式对患者及其脑半球进行分类。将数据与神经功能状态、CT扫描中线移位以及受伤后6个月的格拉斯哥预后量表评分进行关联分析。观察到不同的脑血流动力学模式。1例患者（5.3%）出现脑供血不足，4例患者（21%）出现脑充血，3例患者（15.8%）出现脑血管痉挛。1例患者（5.3%）一个脑半球充血，另一个脑半球出现血管痉挛。10例患者（52.6%）具有非特异性循环模式。9例患者（47.4%）发现TCD循环模式异常。TCD脑血流动力学结果与预后之间无关联。接受DC治疗的TBI患者术后脑血流动力学结果存在广泛的异质性，包括其脑半球之间的血流动力学异质性。DC被证明对治疗脑供血不足有效。我们的数据支持TBI病理生理学异质性的概念，并表明DC作为唯一的治疗方式是不够的。
