title: Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases.
abstract: The role of decompressive craniectomy in the treatment of severe posttraumatic cerebral swelling remains quite a controversial issue. To the best of our knowledge, there is no study demonstrating the effect of decompressive craniectomy on cerebral blood flow (CBF) velocity by means of transcranial Doppler sonography (TCD). We present two patients who developed traumatic brain swelling and uncontrollable intracranial hypertension with coma and signs of transtentorial herniation. One patient underwent bifrontal, while the second, unilateral, frontotemporoparietal decompressive craniectomy with dural expansion. In both patients, TCD examinations were performed immediately before and after surgery to study the cerebral hemodynamic changes related to the operations. Pre and postoperative TCD examinations demonstrated a significant increase in blood flow velocity in the intracranial arteries in both subjects. In conclusion, our cases suggest that decompressive craniectomy with dural expansion may result in elevation of CBF velocity in patients with massive brain swelling. The increase in CBF velocity appears to occur not only in the decompressed hemisphere, but also on the opposite side.
authors.affiliation: Division of Neurosurgery, Hospital das Clínicas, São Paulo University Medical School, São Paulo, SP, Brazil. edsonshu@hotmail.com
authors.forename: Edson
authors.initials: E
authors.lastname: Bor-Seng-Shu
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.forename: Roberto
authors.initials: R
authors.lastname: Hirsch
authors.forename: Almir Ferreira de
authors.initials: AF
authors.lastname: Andrade
authors.forename: Raul
authors.initials: R
authors.lastname: Marino
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000601:surgery; D002560:Cerebrovascular Circulation; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D011184:Postoperative Period; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial / Q000592:standards*