Neurosurgical Patient in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) in Postoperative Monitoring

Abstract

The basic principle of neurosurgical patient management is to ensure adequate brain tissue perfusion, maintaining a sufficient blood flow to supply energy and oxygen to the brain parenchyma. 2. If neuroworsening occurs after a neurosurgical procedure, prompt recognition is essential because it may be the first indication of potential complications. 3. In many clinical scenarios during neurosurgical postoperative period, TCD/ TCCS may have a transcendent role in diminished gap between neurological clinical examination and other investigations that may be invasive or require patient transport outside of the ICU. 4. Midline shift (MLS) monitoring is important for preventing neurological worsening and assess early neurosurgical intervention. Keep in mind that any amount of midline shift is considered abnormal. 5. Measurement of volume of Intracerebral Hematoma (ICH) is a very useful monitoring tool in the daily bedside following, and thus contribute to therapeutic decisions in real time interpreting the clinical trends. 6. The most used approach, to diagnose hydrocephalus by TCCS, is the measurement of the diameter of the third ventricle through the transtemporal window. 7. It is critical to interpret and integrate hemodynamic qualitative and quantitative trends (not only the absolute value) of the Spectral Doppler wave (blood flow velocity patterns) with the clinical context of the patient.