Ulus Travma Acil Cerrahi Derg. 2020; 26(3): 418-424 | DOI: 10.14744/tjtes.2020.04640

Travmatik beyin hasarýnda dekompresif kraniektomi: Transkraniyal Doppler ultrasonografi yol gösterici olabilir mi?

Ramazan Sarý¹, Fatih Han Bolukbasi², Eylem Burcu Kahraman Özlü¹, Nejat Isik³, Melek Güra Çelik⁴, Ýlhan Elmacý^1
1Acýbadem Maslak Hastanesi, Beyin ve Sinir Cerrahisi Kliniði, Ýstanbul
²Rumeli Üniversitesi Saðlýk Bilimleri Fakültesi, Ýstanbul
³Ýstanbul Medeniyet Üniversitesi, Göztepe Eðitim ve Araþtýrma Hastanesi, Beyin ve Sinir Cerrahisi Kliniði, Ýstanbul
⁴Ýstanbul Medeniyet Üniversitesi, Göztepe Eðitim ve Araþtýrma Hastanesi, Anestezi ve Reanimasyon Kliniði, Ýstanbul

AMAÇ: Dekompresif kraniektomi (DC), travmatik beyin hasarý (TBH) sonrasý intrakraniyal hipertansiyon tedavisinde kullanýlan etkin bir yöntemdir. Transkraniyal Doppler ultrasonografi (TCD) ölçümlerinin dekompresif cerrahi endikasyonundaki etkisini göstermektir.
GEREÇ VE YÖNTEM: Çalýþmaya Glasgow Koma Skoru (GCS) <9 olan 16 TBH hastasý alýndý. Ýntrakraniyal basýnç (ICP) izleme ve TCD ölçümleri sürekli olarak kaydedildi. DC, ICP ve TCD kayýtlarýna göre yapýldý. Glasgow Sonuç Ölçeði (GOS) skorlarý 3 ay sonra deðerlendirildi.
BULGULAR: Hastalarýn yaþ ortalamasý 31.18±17.51, GCS 3 ile 14 arasýnda deðiþmekte olup, ortalama 9.62±3.95 idi. Ortalama GOS 3.12±1.85 idi. Ýki hastaya (%12.5) kraniektomi, 14 hastaya (%87.5) kraniektomi ve lobektomi birlikte yapýldý. ICP’deki düþüþ (22.12±10.41, 22.62±7.35, 15.50±6.64) ve pulsatilite indeksi (PI) (1.96±1.10, 1.64±0.75, 1.91±2.48) 3–5 ve 1–5 günleri arasýnda belirgin olarak anlamlýydý. Beþ güne kadar olan PI ve Vmax deðerleri arasýnda anlamlý bir fark bulunmamýþtýr.
TARTIÞMA: TCD, gerçek zamanlý bir monitör olarak, TBH hastalarýnýn tedavisinde cerrahi yaklaþýmýn erken kararýna yardýmcý olabilir.

Anahtar Kelimeler: Dekompresif kraniektomi, nöroyoðun bakým; transkraniyal Doppler ultrasonografi; travmatik beyin hasarý.

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Decompressive craniectomy in traumatic brain injury: Transcranial Doppler sonography used as a guide

Ramazan Sarý¹, Fatih Han Bolukbasi², Eylem Burcu Kahraman Özlü¹, Nejat Isik³, Melek Güra Çelik⁴, Ýlhan Elmacý^1
1Department of Neurosurgery, Acýbadem Maslak Hospital, Ýstanbul-Turkey
²Department of Neurosurgery, Rumeli University Faculty of Health Sciences, Ýstanbul-Turkey
³Department of Neurosurgery, Ýstanbul Medeniyet Universitiy, Göztepe Training and Research Hospital, Ýstanbul-Turkey
⁴Department of Anesthesia and Reanimation, Ýstanbul Medeniyet Universitiy, Göztepe Training and Research Hospital, Ýstanbul-Turkey

BACKGROUND: Decompressive craniectomy (DC) is performed in the management of intracranial hyper-tension after traumatic brain injury (TBI). This study aims to investigate the effects of transcranial Dop-pler ultrasonography (TCD) measurements on the indication of decompressive surgery.
METHODS: Sixteen TBI patients with a Glasgow Coma Score (GCS) <9 were included in this study. Intra-cranial pressure (ICP) monitoring and transcranial Doppler ultrasonography (TCD) measurements were recorded continuously. DC was performed according to the records of ICP and TCD. Glasgow Outcome Scale (GOS) scores were evaluated after three months.
RESULTS: Mean age of the patients was 31.18±17.51; GCS ranged between three and 14 with a mean of 9.62±3.95. Mean GOS was 3.12±1.85. Craniectomy was performed in two patients (12.5%) and cra-niectomy and lobectomy together were performed in 14 (87.5%) of them. The decline in ICP (22.12±10.41, 22.62±7.35, 15.50±6.64) and pulsatility index (PI) (1.96±1.10, 1.64±0.75, 1.91±2.48) were strongly significant between days 3–5, and 1–5. The range of PI and Vmax values through five days did not present any significance.
CONCLUSION: TCD, as a real-time monitor, may help for an early decision of surgical approach in the management of TBI patients.

Keywords: Decompressive craniectomy, neurointensive care; transcranial Doppler ultrasonography; traumatic brain injury.

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