Cerebral Blood Flow and Metabolism Following Decompressive Craniectomy for Control of Increased Intracranial Pressure

Abstract

These results suggest that DC may enhance survival in the presence of severe brain swelling, although it is unlikely to represent an adequate answer to mitochondrial damage responsible for cellular energy crisis and edema.

Comparison of Effects of Equiosmolar Doses of Mannitol and Hypertonic Saline on Cerebral Blood Flow and Metabolism in Traumatic Brain Injury

“…None of the measured global indices of cerebral metabolism showed any significant increase following infusion of either of the hyperosmolar solutions, even in those patients for whom impaired oxidative metabolism was associated with CBF values <25 mL/100g/min. This finding further supports previous reports of nonischemic post-traumatic metabolic failure (Soustiel and Sviri, 2007;Vespa et al, 2005) and failure of other ICP relief measures to improve cerebral metabolism (Chieregato et al, 2007;Soustiel et al, 2006Soustiel et al, , 2010.…”

Improvement of Cerebral Metabolism Mediated by Ro5-4864 is Associated with Relief of Intracranial Pressure and Mitochondrial Protective Effect in Experimental Brain Injury

“…None of these treatment modalities, however, directly addresses the underlying pathophysiology of brain edema and at most would only target its physicochemical aspects such as reduction of brain water content by means of hypertonic fluids. Even if mechanically successful, the concept of ICP control for improvement of cerebral blood flow and metabolism has been recently challenged by a series of recent clinical studies showing that the cerebral metabolic rate of oxygen could not be improved as a result of ICP decrease (4,7,8,29). In these studies, neither optimization of cerebral perfusion pressure, hyperventilation, infusion of hypertonic solutions or decompressive craniectomy showed any significant improvement in oxygen consumption by the injured brain, even though cerebral blood flow could be effectively maintained or elevated by some of these measures.…”

“…Hypothetically, metabolic crisis may therefore share a common pathophysiology with intracranial hypertension rather than being a consequence of it. Such hypothesis is supported by the reported fact that oxidative metabolism does not improve as a consequence of optimization of cerebral perfusion pressure, often as it deteriorates with ICP elevation (4,5,7,8).…”

Factors influencing the decision to retain or remove the bone flap of adult patients with traumatic brain injury: a retrospective study

“…In order to further refine this scoring system into a clinically applicable protocol, a multi-center study is needed to ensure the reproducibility and accuracy of this protocol. With more extensive analysis, we hope to establish a clear numberbased intraoperative decision-making protocol to reduce the unnecessary mortality and morbidity associated with TBI operations and optimize patient outcome (20,24,28).…”