Department of Neurosurgery, The Affiliated Hospital of Qingdao University.
Department of Operating Room, The Affiliated Hospital of Qingdao University.
J Craniofac Surg. 2022;33(8):2400-2405. doi: 10.1097/SCS.0000000000008785. Epub 2022 Jul 27.
Decompressive craniectomy (DC) is widely used to treat intracranial hypertension following severe head injury. However, impairments of cerebrospinal fluid (CSF) hydrodynamics such as hydrocephalus and subdural effusion are common complications that occur after DC. Therefore, monitoring of intracranial pressure is a staple of neurocritical care post-DC. The aim of this study was to assess the usefulness of transcranial duplex sonography (TDS) for serial monitoring and management of CSF disorders after DC.
A total of 100 patients who underwent DC between June 2016 and May 2019 were recruited for the study. Transcranial duplex sonography examinations were performed between 1-day and 1-year post-DC. Transcranial duplex sonography was mainly used for monitoring changes in ventricle size and morphology, and also to monitor intraventricular hemorrhage, hydrocephalus, intracranial hygromas, and ventricle changes during CSF release procedures.
A total of 456 TDS examinations were performed on patients after DC. Of these, 402 were performed in the neuro-intensive care unit. Two patients had intraventricular hemorrhage and underwent TDS-guided external ventricular drainage. Twenty-nine patients were diagnosed with hydrocephalus. The results of TDS were consistent with those of cranial computed tomography. Three cases of ventriculoperitoneal shunt and 1 case of lumbar peritoneal shunt underwent valve pressure reset according to TDS, to obtain satisfactory ventricle size. Transcranial duplex sonography was used to monitor ventricle changes and control drainage volume during CSF release procedures, including 2 external ventricular drainage, 6 external lumbar drainage, and 10 lumbar punctures. Eighteen patients were detected with single or multiple intracranial effusions, including 16 subdural hygromas, 5 longitudinal fissure hygromas, and 6 brain cysts.
Transcranial duplex sonography can efficiently help monitor changes in ventricle size and morphology and intracranial effusions. Due to its noninvasive nature, suitability for bedside application, real-time, and inexpensiveness, TDS can significantly replace cranial computed tomography and become part of the patient's daily inspection work after DC.
去骨瓣减压术（DC）广泛用于治疗严重颅脑损伤后的颅内高压。然而，脑脊液（CSF）动力学受损，如脑积水和硬膜下积液，是 DC 后常见的并发症。因此，颅内压监测是 DC 后神经危重症护理的基础。本研究旨在评估经颅双功超声（TDS）对 DC 后 CSF 障碍的连续监测和管理的有用性。
本研究共纳入 2016 年 6 月至 2019 年 5 月期间行 DC 的 100 例患者。DC 后 1 天至 1 年进行经颅双功超声检查。经颅双功超声主要用于监测脑室大小和形态的变化，也用于监测脑室出血、脑积水、颅内血肿和 CSF 释放过程中脑室变化。
对 DC 后的患者共进行了 456 次 TDS 检查，其中 402 次在神经重症监护病房进行。2 例患者发生脑室出血，行 TDS 引导下的外引流。29 例患者诊断为脑积水。TDS 的结果与头颅 CT 一致。根据 TDS 结果，3 例患者行脑室-腹腔分流术，1 例患者行腰-腹腔分流术，重置阀门压力，获得满意的脑室大小。TDS 用于监测 CSF 释放过程中脑室变化和控制引流体积，包括 2 例外引流，6 例外腰引流和 10 例腰穿。18 例患者检测到单发或多发颅内积液，包括 16 例硬膜下血肿、5 例纵裂血肿和 6 例脑囊肿。
经颅双功超声可以有效地帮助监测脑室大小和形态以及颅内积液的变化。由于其具有非侵入性、适合床边应用、实时和经济的特点，TDS 可以显著替代头颅 CT，并成为 DC 后患者日常检查工作的一部分。
