Decompressive Craniectomy for Traumatic Brain Injury: Postoperative Cerebral Hemodynamic Evaluation

Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient. Introduction Decompressive craniectomy (DC) may effectively decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in traumatic brain injury (TBI) patients with refractory elevated ICP (1, 2). However, randomized controlled trials failed to disclose the efficacy of this procedure for improving these patients' neurological outcome (3, 4). This means that ICP control to ensure CPP, as the sole treatment strategy, is not sufficient to achieve satisfactory therapeutic results in most cases. New research should focus on different pathophysiological mechanisms of posttraumatic brain swelling. Transcranial Doppler (TCD) ultrasonography is a non-invasive and bedside method for real-time assessment of cerebral blood circulation. This technique is routinely used in clinical and scientific scenario (5–8). To date, few studies have addressed the cerebral hemodynamic and metabolic effects of DC for uncontrolled elevation of ICP (2, 9–15). To our knowledge, there are no studies describing the different cerebral hemo...
Source: Frontiers in Neurology - Category: Neurology Source Type: research

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