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01-06-2012 | Review

Cerebral Blood Flow, Brain Tissue Oxygen, and Metabolic Effects of Decompressive Craniectomy

Authors: Christos Lazaridis, Marek Czosnyka

Published in: Neurocritical Care | Issue 3/2012

Abstract

Decompressive craniectomy (DC) is used for patients with traumatic brain injury (TBI), malignant edema from middle cerebral artery infarction, aneurysmal subarachnoid hemorrhage, and non-traumatic intracerebral or cerebellar hemorrhage. The objective of the procedure is to relieve intractable intracranial hypertension and/or to prevent or reverse cerebral herniation. Decompressive craniectomy has been shown to decrease mortality in selected patients with large hemispheric infarction and to control intracranial pressure in addition to improving pressure–volume compensatory reserve after TBI. The clinical effectiveness of DC in patients with TBI is under evaluation in ongoing randomized clinical trials. There are several unresolved controversies regarding optimal candidate selection, timing, technique, and post-operative management and complications. The nature and temporal progression of alterations in cerebral blood flow, brain tissue oxygen, and microdialysis markers have only recently been researched. Elucidating the pathophysiology of pressure-flow and cerebral hemodynamic consequences of DC could assist in optimizing clinical decision making and further defining the role of decompressive craniectomy.

Sahuqillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev. 2006;25(1):CD003983. Review.

Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–22.PubMedCrossRef

Güresir E, Schuss P, Vatter H, Raabe A, Seifert V, Beck J. Decompressive craniectomy in subarachnoid hemorrhage. Neurosurg Focus. 2009;26(6):E4.PubMedCrossRef

Murthy JM, Chowdary GV, Murthy TV, Bhasha PS, Naryanan TJ. Decompressive craniectomy with clot evacuation in large hemispheric hypertensive intracerebral hemorrhage. Neurocrit Care. 2005;2:258–62.PubMedCrossRef

Olivecrona M, Rodling-Wahlström M, Naredi S, Koskinen LO. Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma. 2007;24:927–35.PubMedCrossRef

Whitfield PC, Patel H, Hutchinson PJ, et al. Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension. Br J Neurosurg. 2001;15:500–7.PubMedCrossRef

Cooper DJ, Rosenfeld JV, Murray L, et al. DECRA trial investigators; Australian and New Zealand intensive care society clinical trials group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–502.PubMedCrossRef

Hutchinson PJ, Kirkpatrick PJ. RESCUEicp Central Study Team. Craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;365(4):375.

Yamakami I, Yamaura A. Effects of decompressive craniectomy on regional cerebral blood flow in severe head trauma patients. Neurol Med Chir (Tokyo). 1993;33:616–20.CrossRef

10.

Heppner P, Ellegala DB, Durieux M, Jane JA Sr, Lindner JR. Contrast ultrasonographic assessment of cerebral perfusion in patients undergoing decompressive craniectomy for traumatic brain injury. J Neurosurg. 2006;104:738–45.PubMedCrossRef

11.

Rim SJ, Leong-Poi H, Lindner JR, et al. Quantification of cerebral perfusion with “Real-Time” contrast-enhanced ultrasound. Circulation. 2001;104:2582–7.PubMedCrossRef

12.

Vogel R, Indermuhle A, Reinhardt J, et al. The quantification of absolute myocardial perfusion in humans by contrast echocardiography: algorithm and validation. J Am Coll Cardiol. 2005;45:754–62.PubMedCrossRef

13.

Timofeev I, Czosnyka M, Nortje J, et al. Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury”. J Neurosurg. 2008;108:66–73.PubMedCrossRef

14.

Ho CL, Wang CM, Lee KK, Ng I, Ang BT. Cerebral oxygenation, vascular reactivity, and neurochemistry following decompressive craniectomy for severe traumatic brain injury. J Neurosurg. 2008;108:943–9.PubMedCrossRef

15.

Wang EC, Ang BT, Wong J, Lim J, Ng I. Characterization of cerebrovascular reactivity after craniectomy for acute brain injury. Br J Neurosurg. 2006;20:24–30.PubMedCrossRef

16.

Aaslid R. Cerebral hemodynamics. In: Newell DW, Aaslid R, editors. Transcranial doppler. New York: Raven Press; 1992. p. 49–55.

17.

Czosnyka M, Richards HK, Whitehouse HE, Pickard JD. Relationship between transcranial Doppler-determined pulsatility index and cerebrovascular resistance: an experimental study. J Neurosurg. 1996;84:79–84.PubMedCrossRef

18.

Gosling RG, King DH. Arterial assessment by Doppler shift ultrasound. Proc R Soc Med. 1974;67:447–9.PubMed

19.

Michel E, Zernikow B. Gosling’s Doppler pulsatility index revisited. Ultrasound Med Biol. 1998;24:597–9.PubMedCrossRef

20.

Bor-Seng-Shu E, Hirsch R, Teixeira MJ, De Andrade AF, Marino R Jr. Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression. J Neurosurg. 2006;104:93–100.PubMedCrossRef

21.

Daboussi A, Minville V, Leclerc-Foucras S, et al. Cerebral hemodynamic changes in severe head injury patients undergoing decompressive craniectomy. J Neurosurg Anesthesiol. 2009;21:339–45.PubMedCrossRef

22.

Lazaridis C, DeSantis SM, Vandergrift AW, Krishna V. Cerebral blood flow velocity changes and the value of the pulsatility index post decompressive craniectomy: report of 2 cases and literature review. J Clin Neurosci 2011. doi:10.1016/j.jocn.2011.08.039.

23.

Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard J. Continuous assessment of cerebral vasomotor reactivity in head injury. Neurosurgery. 1997;41:11–9.PubMedCrossRef

24.

Steiner LA, Czosnyka M, Piechnik SK, et al. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med. 2002;30:733–8.PubMedCrossRef

25.

Le Roux P, Newell DW, Lam AM, Grady MS, Winn HR. Cerebral arteriovenous difference of oxygen: a predictor of cerebral infarction and outcome in severe head injury. J Neurosurg. 1997;87:1–8.PubMedCrossRef

26.

Stiefel MF, Udoetek J, Spiotta AM, et al. Conventional neurocritical care does not ensure cerebral oxygenation after traumatic brain injury. J Neurosurg. 2006;105:568–75.PubMedCrossRef

27.

Vespa PM, O’Phelan K, McArthur D, et al. Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion pressure. Crit Care Med. 2007;35:1153–60.PubMedCrossRef

28.

Stiefel MF, Heuer GG, Smith MJ, et al. Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg. 2004;101:241–7.PubMedCrossRef

29.

Weiner GM, Lacey MR, Mackenzie L, et al. Decompressive craniectomy for elevated intracranial pressure and its effect on the cumulative ischemic burden and therapeutic intensity levels after severe traumatic brain injury. Neurosurgery. 2010;66:1111–8.PubMedCrossRef

30.

Jaeger M, Soehle M, Meixensberger J. Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatry. 2003;74:513–5. Review.PubMedCrossRef

31.

Soustiel JF, Sviri GE, Mahamid E, Shik V, Abeshaus S, Zaaroor M. Cerebral blood flow and metabolism following decompressive craniectomy for control of increased intracranial pressure. Neurosurgery. 2010;67:65–72.PubMedCrossRef

32.

Stiver SI. Complications of decompressive craniectomy for traumatic brain injury. Neurosurg Focus. 2009;26(6):E7. Review.PubMedCrossRef

33.

Kakar V, Nagaria J, John Kirkpatrick P. The current status of decompressive craniectomy. Br J Neurosurg. 2009;23:147–57. Review.PubMedCrossRef

34.

Winkler PA, Stummer W, Linke R, Krishnan KG, Tatsch K. Influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism. J Neurosurg. 2000;93(1):53–61.PubMed

35.

Richaud J, Boetto S, Guell A, Lazorthes Y. Effects of cranioplasty on neurological function and cerebral blood flow. Neuro-Chirurgie. 1985;31:183–8.PubMed

36.

Isago T, Nozaki M, Kikuchi Y, Honda T, Nakazawa H. Sinking skin flap syndrome: a case of improved cerebral blood flow after cranioplasty. Ann Plast Surg. 2004;53:288–92.PubMedCrossRef

37.

Maeshima S, Kagawa M, Kishida Y, et al. Unilateral spatial neglect related to a depressed skin flap following decompressive craniectomy. Eur Neurol. 2005;53:164–8.PubMedCrossRef

38.

Stiver SI, Wintermark M, Manley GT. Reversible monoparesis following decompressive hemicraniectomy for traumatic brain injury. J Neurosurg. 2008;109:245–54.PubMedCrossRef

39.

Kemmling A, Duning T, Lemcke L, et al. Case report of MR perfusion imaging in sinking skin flap syndrome: growing evidence for hemodynamic impairment. BMC Neurol. 2010;11(10):80.CrossRef

Title: Cerebral Blood Flow, Brain Tissue Oxygen, and Metabolic Effects of Decompressive Craniectomy
Authors: Christos Lazaridis
Marek Czosnyka
Publication date: 01-06-2012
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 3/2012
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-012-9685-1

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Cerebral Blood Flow, Brain Tissue Oxygen, and Metabolic Effects of Decompressive Craniectomy

Abstract

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