Ravikanth Reddy, Majumdar Pooja
Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India.
Department of Medicine, Indian Naval Hospital Ship (INHS) Kalyani, Gandhigram P.O, Visakhapatnam, Andhra Pradesh, India.
Neurol India. 2022 Sep-Oct;70(5):1840-1845. doi: 10.4103/0028-3886.359228.
Intracerebral hemorrhage is a leading cause of death and disability worldwide. After intracerebral hemorrhage, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post-injury. Identification of such hemodynamic disturbances can be used to predict outcome immediately post-injury when indices are measured using transcranial doppler ultrasonography (TCD). TCD permits non-invasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome.
To investigate the effect of cerebral hemodynamics after cranioplasty in decompressive craniectomy patients using pre and postoperative TCD.
This study is a prospective study of 3 years duration undertaken on 64 patients. All the patients were evaluated by TCDbefore and after decompressive craniectomy.All patients were evaluated by transcranial Doppler (TCD) 1 week before and 7-15 days after cranioplasty. TCD results were obtained though trans-temporal approach.
Statistically significant differences between the values before and after craniectomy were detected in Peak Systolic Volume (PSV) for the Anterior Cerebral Artery (ACA) (P = 0.001), in PSV for the Middle Cerebral Artery (MCA) (P < 0.004), in Mean Bloodflow Velocity (MV) for the MCA (P < 0.003), and in PSV for the Posterior Cerebral artery (PCA) (P = 0.001) on the ipsilateral side. There were statistically significant differences between the values before and after cranioplasty in PSV for the PCA (P = 0.004), on contralateral side.After decompressive craniectomy, the PI values for the MCA decreased, on average, to 31+/- 33% of the pre-surgical value in the treated side and to 28+/- 31% on the opposite side. On the other hand, the mean PI values for the extracranial ICA reduced to 34+/- 21% of the initial values in the treated side, and to 21+/- 31% on the opposite side.Cranioplasty improved CBF velocities in all major intracrainal arteries, not only on the side of the lesion adjacent to the cranioplasty, but also in distant regions, such as in the contralateral hemisphere.
Decompressive craniectomy significantly improves cerebral hemodynamics both on ipsilateral and contralateral cerebral hemispheres.Concomitantly, PI values on TCD decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance. We conclude that cranioplasty improves neurological status and the mechanism of postoperative improvement of neurological status may be due to increased CBF velocity.
脑出血是全球范围内导致死亡和残疾的主要原因。脑出血后，脑血流量（CBF）极低，接近缺血阈值。同时，损伤后脑血流量速度与脑血流量本身密切相关。当使用经颅多普勒超声（TCD）测量指标时，识别这种血流动力学紊乱可用于预测损伤后即刻的预后。TCD允许对不同的脑血流量速度以及搏动指数（PI）进行无创评估。据信这些指标的异常测量与不良预后相关。
使用术前和术后TCD研究减压性颅骨切除术患者颅骨成形术后脑血流动力学的影响。
本研究是一项对64例患者进行的为期3年的前瞻性研究。所有患者在减压性颅骨切除术前和术后均通过TCD进行评估。所有患者在颅骨成形术前1周和术后7 - 15天通过经颅多普勒（TCD）进行评估。通过颞部途径获得TCD结果。
在同侧，大脑前动脉（ACA）的收缩期峰值流速（PSV）（P = 0.001）、大脑中动脉（MCA）的PSV（P < 0.004）、MCA的平均血流速度（MV）（P < 0.003）以及大脑后动脉（PCA）的PSV（P = 0.001）在颅骨切除术前和术后的值之间存在统计学显著差异。在对侧，颅骨成形术前和术后PCA的PSV值之间存在统计学显著差异（P = 0.004）。减压性颅骨切除术后，MCA的PI值平均降至手术治疗侧术前值的31±33%，对侧降至28±31%。另一方面，颅外颈内动脉的平均PI值在手术治疗侧降至初始值的34±21%，对侧降至21±31%。颅骨成形术改善了所有主要颅内动脉的脑血流量速度，不仅在与颅骨成形术相邻的病变侧，而且在远处区域，如对侧半球。
减压性颅骨切除术显著改善同侧和对侧大脑半球的脑血流动力学。同时，术后TCD上的PI值显著降低，主要在减压的大脑半球，表明脑血管阻力降低。我们得出结论，颅骨成形术改善神经功能状态，术后神经功能状态改善的机制可能是由于脑血流量速度增加。
