Cerebral hemodynamic changes in severe head injury patients undergoing decompressive craniectomy.
OBJECTIVE
To assess the intracranial hemodynamic modifications induced by a decompressive craniectomy (DC) after severe traumatic brain injury (TBI), using transcranial Doppler (TCD) ultrasonography and intracranial pressure (ICP) sensor. Mortality rate and neurological outcomes were also evaluated after this procedure.


METHODS
A prospective study was carried out on 26 TBI patients, measuring transcranial Doppler and ICP before, immediately after, and 48 hours after the DC, allowing for statistical analysis of hemodynamic changes. The mortality rate and the neurological outcomes were assessed.


RESULTS
After DC, ICP decreased from 37+/-17 to 20+/-13 mm Hg (P=0.0003). The global cerebral blood flow was modified with diastolic velocities rising from 23+/-15 to 31+/-13 cm/s (P=0.0038) and a pulsatility index decreasing from 1.70+/-0.66 to 1.18+/-0.37 (P=0.0012). This normalization of the global cerebral hemodynamics after the DC was immediate, symmetric, and constant during the first 48 hours. Outcome was evaluated at 6 months: good recovery or moderate disability was observed in 11 patients (42%), persistent vegetative state in 7 patients (27%), and 8 patients died (31%).


CONCLUSIONS
The DC results in a significant, immediate, and durable improvement of ICP associated with a normalization of cerebral blood flow velocities in most TBI patients with refractory intracranial hypertension.
Daboussi
Amel
A
Service de Médecine Nucléaire, CHU Purpan, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
Minville
Vincent
V
Leclerc-Foucras
Sophie
S
Geeraerts
Thomas
T
Esquerré
Jean Paul
JP
Payoux
Pierre
P
Fourcade
Olivier
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001929:Brain Edema / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006259:Craniocerebral Trauma / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D003399:Craniotomy; D019299:Decompression, Surgical; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000523:psychology; D017741:Survivors; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult