Vascular tunnel creation to improve the efficacy of decompressive craniotomy in post-traumatic cerebral edema and ischemic stroke

Csókay, András; Együd, László; Nagy, László; Pataki, Gergely

doi:10.1016/s0090-3019(01)00686-3

Cited by 42 publications

(28 citation statements)

References 20 publications

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“…However, the actual benefit of this surgical procedure on patient outcome remains a controversial issue in neurosurgical literature. There is no conclusion as to how effective this surgical treatment 716 Arq Neuropsiquiatr 2004;62 (3-A) is, despite a series of publications 2,[12][13][14][15][16][17][18][19][20] . Moreover, there are few investigations in the literature concerning the hemodynamic benefits following a decompressive craniectomy 21,22 .…”

Section: Doppler Transcraniano Em Doentes Com Tumefação Encefálica Pómentioning

confidence: 99%

Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases

Bor-Seng-Shu

Teixeira

Hirsch³

et al. 2004

Arq. Neuro-Psiquiatr.

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To date, despite modern advances in understanding, monitoring, and treating increased intracranial pressure (ICP), patients suffering from uncontrollable intracranial hypertension due to traumatic brain swelling most often either die or survive in an extremely disabled state [1][2][3] . It is well known that intracranial hypertension can lead to a reduction in cerebral perfusion pressure (CPP) and a potential ABSTRACT -The role of decompressive craniectomy in the treatment of severe posttraumatic cerebral swelling remains quite a controversial issue. To the best of our knowledge, there is no study demonstrating the effect of decompressive craniectomy on cerebral blood flow (CBF) velocity by means of transcranial Doppler sonography (TCD). We present two patients who developed traumatic brain swelling and uncontrollable intracranial hypertension with coma and signs of transtentorial herniation. One patient underwent bifrontal, while the second, unilateral, frontotemporoparietal decompressive craniectomy with dural expansion. In both patients, TCD examinations were performed immediately before and after surgery to study the cerebral hemodynamic changes related to the operations. Pre and postoperative TCD examinations demonstrated a significant increase in blood flow velocity in the intracranial arteries in both subjects. In conclusion, our cases suggest that decompressive craniectomy with dural expansion may result in elevation of CBF velocity in patients with massive brain swelling. The increase in CBF velocity appears to occur not only in the decompressed hemisphere, but also on the opposite side.KEY WORDS: brain swelling, cerebral hemodynamics, decompressive craniectomy, head injury, intracranial hypertension, transcranial Doppler sonography. Doppler transcraniano em doentes com tumefação encefálica pós-traumática submetidos à craniectomia descompressiva: relato de dois casosRESUMO -Atualmente, as controvérsias sobre os benefícios da craniectomia descompressiva no tratamento de doentes com tumefação encefálica pós-traumática ainda existem. Não há estudos disponíveis na literatura médica sobre os efeitos da craniectomia descompressiva na hemodinâmica encefálica avaliados pelo Doppler transcraniano. Estudamos dois doentes com tumefação encefálica pós-traumática associada à hipertensão intracraniana e evidências de herniação transtentorial. Um deles foi submetido à craniectomia bifrontal e outro, à craniectomia frontoparietotemporal unilateral. O primeiro doente apresentou seqüela neurológi-ca moderada e reintegração social, enquanto o segundo manteve-se em estado vegetativo. Exames de Doppler transcraniano realizados imediatamente antes e após a cirurgia revelaram aumento significativo da velocidade do fluxo sangüíneo nas artérias intracranianas de ambos os doentes. Concluiu-se que a craniectomia descompressiva com plástica de ampliação da dura-máter pode resultar em elevação da velocidade do fluxo sangüíneo encefálico nestes doentes. O aumento da velocidade do fluxo sangüíneo pode ocorrer nos hemisfé-rios cerebra...

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Section: Doppler Transcraniano Em Doentes Com Tumefação Encefálica Pómentioning

confidence: 99%

Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases

Bor-Seng-Shu

Teixeira

Hirsch³

et al. 2004

Arq. Neuro-Psiquiatr.

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“…Csokay et al have reported a method by which this secondary brain injury may be reduced when using decompressive craniectomy for trauma. 17 This involves creating a vascular tunnel by suturing ''Bethlehem cushions'' made of absorbable gelatine either side of the cortical vessels as they pass under the edge of the dura. It is possible that this technical adjunct may also be useful in reducing brain oedema in MMI.…”

Section: Dural Openingmentioning

confidence: 99%

Technical aspects of decompressive craniectomy for malignant middle cerebral artery infarction

Johnson

Maartens

Teddy

2011

Journal of Clinical Neuroscience

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“…De Luca та співавтори [24] у вибірці з 22 пацієнтів відзначили позитивні результати у 41%, летальність 18%. В іншому дослідженні [25] сприятливий результат відзна-чений у 38% пацієнтів, у яких початковий стан за ШКГ становив 3-4 бали, смертність -43%. У невеликій вибірці (9 пацієнтів) [26] сприятливі результати досягнуті у 66% спостережень, смер-тність становила 22%, частота тяжкої інвалідиза-ції -11%.…”

Section: дåêîìïðåñèвíà êðàí³åêòîì³я ó ïîòåðï³ëèх ç òяAeêîю чåðåïíî-ìîunclassified

Decompressive craniectomy performing at severe cranio-cerebral trauma

Pedachenko¹,

Dzyak²,

Sirko³

2011

Ukr Neurosurg J

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Vascular tunnel creation to improve the efficacy of decompressive craniotomy in post-traumatic cerebral edema and ischemic stroke

Cited by 42 publications

References 20 publications

Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases

Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases

Technical aspects of decompressive craniectomy for malignant middle cerebral artery infarction

Decompressive craniectomy performing at severe cranio-cerebral trauma

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