Introduction: This study focused on the predictive role of transcranial color ultrasound (TCU) in prior to post-operative computed tomography (CT) scan for patients with decompressive craniectomy. By measuring subcortical blood flow (sCxBF) of temporal lobe, we try to establish the correlation between its significance and prognosis
Methods: Between Mar. 2011 to June. 2012, twenty patients with traumatic intracranial hemorrhage with mass effect (including subdural hematoma, contusing intraparenchymal hematoma) underwent large-field hemicraniectomy. The bedside TCU were performed immediately before post-operative CT on account of clinical indications. The records and imaging data were retrospectively reviewed with regard to midline shift, maximal hematoma diameter, lateral ventricle size and sCxBF. The Glascow Coma Scale (GCS) alteration and outcome assessment (by modified Rankin scale, mRS) were analyzed by linear regression statistic. The values of sCxBF were dichotomized to determine the threshold to predict the good and poor recovery.
Results: In comparing all radiological parameters, the midline shift, hematoma difference and newly-onset hydrocephalus can be of good association (Pearson coefficient: 0.97, p<0.01); the mean velocity of 35cm/s of sCxBF and more are associated with better outcome in our cohort (p<0.01)
Conclusions: Our preliminary cohort and limited data support the application of bedside TCU as a simple and easy tool for post-operative intracranial screening and monitoring. A prospective randomized study is indicated to validate the critical value of sCxBF that correlated with patients outcomes.
Patient Care: 1.Real-time monitoring and detecting the intracranial condition.
2.Minimize the risks during the critical transportation between the examine room and ICU.
3.Early preparation for forward surgical planning and
predict the potential outcome.
Learning Objectives: Using a minimalistic method to detect the brain condition after the craniectomy; practitioner can make
the real-time comparison between the baseline CT image and the ultrasound pictures. We try to define the prognostic factor to correlate the outcome result.
References: 1. Brain Trauma Foundation: Guidelines for the surgical management of traumatic brain injury.
Neurosurgery 2006; 5(8): S2-1-62.
2. Caricato A, Mignani V, Bocci MG, et al: Usefulness of transcranial echography in patients with
decompressive craniectomy: a comparison with computed tomography scan. Crit Care Med 2012;40(6):
1745-52
3. Heppner P, Ellegala DB, Durieux M, et al: Contrast ultrasonographic assessment of cerebral
perfusion in patients undergoing decompressive craniectomy for traumatic brain injury. J neurosurg 2006;
104(5):783-45
4. Hutchinson PJ, Cor teen E, Czosnyka M, et al: Decompressive craniectomy in traumatic brain
injury:The randomized multicenter RESCUE study, Acta Neurochir 2006;Suppl 96: 17-20.
5. Lazaridis C, DeSantis SM, Vandergrift AW, et al: Cerebral blood flow velocity changes and the
value of the pulsatility index post decompressive craniectomy. J Clin Neurosci 2012; 19(7):1052-4
6. Puppo C, Camacho J, Yelicich B, et al: Bedside study of cerebral critical closing pressure in patients
with severe traumatic brain injury: a transcranial Doppler study. Acta Neurochir Suppl 2012; 114:283-8
7. Taylor A, Butt W, Rosenfeld J, et al.: A randomized trial of very early decompresssive craniectomy
in children with traumatic brain injury and sustained intracranial hypertension.Childs Nerv Syst
2001;17:154-162.