Rebai Lotfi, Nsiri Wissal, Kalai Firas, Ben Brahem Sabrine, Faten Olfa, Ardhaoui Ichraf
Department of Anesthesiology and critical care, Traumatology and Severe Burns Center, Ben Arous, Tunisia.
Surg Neurol Int. 2025 Jul 25;16:308. doi: 10.25259/SNI_423_2025. eCollection 2025.
Craniotomy for supratentorial tumor resection can alter cerebral hemodynamics, potentially leading to post-operative complications. Transcranial color-coded duplex sonography (TCCD) provides a noninvasive method for evaluating cerebral perfusion and predicting outcomes. The objective of this study was to assess the prognostic value of TCCD parameters, particularly pulsatility index (PI) and diastolic velocity (DV), in predicting post-operative complications following elective craniotomy for supratentorial tumor resection.
This prospective, observational study included 48 adult patients undergoing supratentorial tumor resection. TCCD was performed preoperatively and postoperatively to measure PI, systolic velocity (SV), DV, and mean velocity (MV). Patients with signs of intracranial pressure hypertension (high) were identified based on clinical and radiological parameters. Post-operative clinical and radiological complications were recorded. ROC curve analyses were performed to determine the predictive value of transcranial Doppler parameters.
Post-operative SV and MV significantly increased compared to pre-operative values ( = 0.008 and = 0.037, respectively), while PI and DV remained stable. Pre-operative elevated PI and decreased DV were significantly associated with post-operative complications, including delayed awakening and ischemia. Postoperative PI predicted ischemia with an area under the curve (AUC) of 0.86 and delayed awakening with an AUC of 0.89. Lower DV values were predictive of seizures, ischemia, and delayed awakening. Elevated PI and reduced DV correlated with longer intensive care unit stays.
TCCD is a valuable, non-invasive tool for early identification of patients at risk for post-operative complications following craniotomy for tumor resection. Monitoring PI and DV may guide post-operative management and improve outcomes.
幕上肿瘤切除开颅手术可改变脑血流动力学，可能导致术后并发症。经颅彩色编码双功超声（TCCD）提供了一种评估脑灌注和预测预后的非侵入性方法。本研究的目的是评估TCCD参数，特别是搏动指数（PI）和舒张期速度（DV），在预测幕上肿瘤切除择期开颅术后并发症方面的预后价值。
这项前瞻性观察性研究纳入了48例接受幕上肿瘤切除的成年患者。术前和术后进行TCCD测量PI、收缩期速度（SV）、DV和平均速度（MV）。根据临床和影像学参数确定有颅内压升高迹象（高）的患者。记录术后临床和影像学并发症。进行ROC曲线分析以确定经颅多普勒参数的预测价值。
与术前值相比，术后SV和MV显著增加（分别为P = 0.008和P = 0.037），而PI和DV保持稳定。术前PI升高和DV降低与术后并发症显著相关，包括苏醒延迟和缺血。术后PI预测缺血的曲线下面积（AUC）为0.86，预测苏醒延迟的AUC为0.89。较低的DV值可预测癫痫发作、缺血和苏醒延迟。PI升高和DV降低与重症监护病房住院时间延长相关。
TCCD是一种有价值的非侵入性工具，可早期识别肿瘤切除开颅术后有术后并发症风险的患者。监测PI和DV可指导术后管理并改善预后。
