Contrast ultrasonographic assessment of cerebral perfusion in patients undergoing decompressive craniectomy for traumatic brain injury

Peter Heppner, Dilantha B. Ellegala, Marcel Durieux, John A. Jane, Jonathan Lindner

    Research output: Contribution to journalArticle

    49 Citations (Scopus)

    Abstract

    Object. The aims of this study were to determine whether contrast-enhanced ultrasonography (CEU) could be used for noninvasive evaluation of cerebral perfusion in patients with traumatic brain injury (TBI) and to assess the effect of decompressive surgery on cerebral perfusion as measured by CEU. Methods. Contrast-enhanced ultrasonography with intravenous administration of a microbubble contrast agent was performed in six patients with TBI undergoing decompressive craniectomy. Contrast-enhanced ultrasonography was performed through a bur hole before craniectomy and through the calvarial defect immediately after craniectomy and on postoperative Days 1 and 2. For the latter two studies, patients were placed in the recumbent position and at a 35° incline to investigate changes in perfusion produced by modulation of intracranial pressure (ICP). Cerebral microvascular blood flow increased by almost threefold immediately after craniectomy, from a mean of 7.5 ± 6.9 (standard deviation [SD]) to 20.9 ± 11.6 (p <0.05), and further improved on postoperative Day 1 (mean 37.1 ± 13.9 [SD], p <0.05, compared with postcraniectomy microvascular blood flow) without subsequent change on Day 2. The change in microvascular perfusion correlated inversely with the initial ICP (p <0.01), indicating less recovery of flow when preoperative ICP was markedly elevated. On postoperative Days 1 and 2, head-of-bed elevation produced an increase in microvascular perfusion on CEU (mean 37 ± 11 compared with 51 ± 20, p <0.05) and a small decrease in ICP (mean 16 ± 5 mm Hg compared with 12 ± 4 mm Hg, p <0.05). In patients with parenchymal hematoma, CEU provided spatial information on perfusion abnormalities in the hemorrhagic core and surrounding tissues. Conclusions. Contrast-enhanced ultrasonography has potential for the intraoperative and bedside assessment of cerebral perfusion in patients with TBI. The technique may be appropriate for evaluating responses to therapies aimed at preventing secondary ischemia and for assessing regional perfusion abnormalities.

    Original languageEnglish (US)
    Pages (from-to)738-745
    Number of pages8
    JournalJournal of Neurosurgery
    Volume104
    Issue number5
    DOIs
    StatePublished - May 2006

    Fingerprint

    Decompressive Craniectomy
    Perfusion
    Ultrasonography
    Intracranial Pressure
    Cerebrovascular Circulation
    Microbubbles
    Traumatic Brain Injury
    Hematoma
    Intravenous Administration
    Contrast Media
    Ischemia
    Head

    Keywords

    • Blood flow
    • Cerebral perfusion
    • Microvasculature
    • Traumatic brain injury
    • Ultrasonography

    ASJC Scopus subject areas

    • Clinical Neurology
    • Neuroscience(all)

    Cite this

    Contrast ultrasonographic assessment of cerebral perfusion in patients undergoing decompressive craniectomy for traumatic brain injury. / Heppner, Peter; Ellegala, Dilantha B.; Durieux, Marcel; Jane, John A.; Lindner, Jonathan.

    In: Journal of Neurosurgery, Vol. 104, No. 5, 05.2006, p. 738-745.

    Research output: Contribution to journalArticle

    Heppner, Peter ; Ellegala, Dilantha B. ; Durieux, Marcel ; Jane, John A. ; Lindner, Jonathan. / Contrast ultrasonographic assessment of cerebral perfusion in patients undergoing decompressive craniectomy for traumatic brain injury. In: Journal of Neurosurgery. 2006 ; Vol. 104, No. 5. pp. 738-745.
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    abstract = "Object. The aims of this study were to determine whether contrast-enhanced ultrasonography (CEU) could be used for noninvasive evaluation of cerebral perfusion in patients with traumatic brain injury (TBI) and to assess the effect of decompressive surgery on cerebral perfusion as measured by CEU. Methods. Contrast-enhanced ultrasonography with intravenous administration of a microbubble contrast agent was performed in six patients with TBI undergoing decompressive craniectomy. Contrast-enhanced ultrasonography was performed through a bur hole before craniectomy and through the calvarial defect immediately after craniectomy and on postoperative Days 1 and 2. For the latter two studies, patients were placed in the recumbent position and at a 35° incline to investigate changes in perfusion produced by modulation of intracranial pressure (ICP). Cerebral microvascular blood flow increased by almost threefold immediately after craniectomy, from a mean of 7.5 ± 6.9 (standard deviation [SD]) to 20.9 ± 11.6 (p <0.05), and further improved on postoperative Day 1 (mean 37.1 ± 13.9 [SD], p <0.05, compared with postcraniectomy microvascular blood flow) without subsequent change on Day 2. The change in microvascular perfusion correlated inversely with the initial ICP (p <0.01), indicating less recovery of flow when preoperative ICP was markedly elevated. On postoperative Days 1 and 2, head-of-bed elevation produced an increase in microvascular perfusion on CEU (mean 37 ± 11 compared with 51 ± 20, p <0.05) and a small decrease in ICP (mean 16 ± 5 mm Hg compared with 12 ± 4 mm Hg, p <0.05). In patients with parenchymal hematoma, CEU provided spatial information on perfusion abnormalities in the hemorrhagic core and surrounding tissues. Conclusions. Contrast-enhanced ultrasonography has potential for the intraoperative and bedside assessment of cerebral perfusion in patients with TBI. The technique may be appropriate for evaluating responses to therapies aimed at preventing secondary ischemia and for assessing regional perfusion abnormalities.",
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    AU - Ellegala, Dilantha B.

    AU - Durieux, Marcel

    AU - Jane, John A.

    AU - Lindner, Jonathan

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    N2 - Object. The aims of this study were to determine whether contrast-enhanced ultrasonography (CEU) could be used for noninvasive evaluation of cerebral perfusion in patients with traumatic brain injury (TBI) and to assess the effect of decompressive surgery on cerebral perfusion as measured by CEU. Methods. Contrast-enhanced ultrasonography with intravenous administration of a microbubble contrast agent was performed in six patients with TBI undergoing decompressive craniectomy. Contrast-enhanced ultrasonography was performed through a bur hole before craniectomy and through the calvarial defect immediately after craniectomy and on postoperative Days 1 and 2. For the latter two studies, patients were placed in the recumbent position and at a 35° incline to investigate changes in perfusion produced by modulation of intracranial pressure (ICP). Cerebral microvascular blood flow increased by almost threefold immediately after craniectomy, from a mean of 7.5 ± 6.9 (standard deviation [SD]) to 20.9 ± 11.6 (p <0.05), and further improved on postoperative Day 1 (mean 37.1 ± 13.9 [SD], p <0.05, compared with postcraniectomy microvascular blood flow) without subsequent change on Day 2. The change in microvascular perfusion correlated inversely with the initial ICP (p <0.01), indicating less recovery of flow when preoperative ICP was markedly elevated. On postoperative Days 1 and 2, head-of-bed elevation produced an increase in microvascular perfusion on CEU (mean 37 ± 11 compared with 51 ± 20, p <0.05) and a small decrease in ICP (mean 16 ± 5 mm Hg compared with 12 ± 4 mm Hg, p <0.05). In patients with parenchymal hematoma, CEU provided spatial information on perfusion abnormalities in the hemorrhagic core and surrounding tissues. Conclusions. Contrast-enhanced ultrasonography has potential for the intraoperative and bedside assessment of cerebral perfusion in patients with TBI. The technique may be appropriate for evaluating responses to therapies aimed at preventing secondary ischemia and for assessing regional perfusion abnormalities.

    AB - Object. The aims of this study were to determine whether contrast-enhanced ultrasonography (CEU) could be used for noninvasive evaluation of cerebral perfusion in patients with traumatic brain injury (TBI) and to assess the effect of decompressive surgery on cerebral perfusion as measured by CEU. Methods. Contrast-enhanced ultrasonography with intravenous administration of a microbubble contrast agent was performed in six patients with TBI undergoing decompressive craniectomy. Contrast-enhanced ultrasonography was performed through a bur hole before craniectomy and through the calvarial defect immediately after craniectomy and on postoperative Days 1 and 2. For the latter two studies, patients were placed in the recumbent position and at a 35° incline to investigate changes in perfusion produced by modulation of intracranial pressure (ICP). Cerebral microvascular blood flow increased by almost threefold immediately after craniectomy, from a mean of 7.5 ± 6.9 (standard deviation [SD]) to 20.9 ± 11.6 (p <0.05), and further improved on postoperative Day 1 (mean 37.1 ± 13.9 [SD], p <0.05, compared with postcraniectomy microvascular blood flow) without subsequent change on Day 2. The change in microvascular perfusion correlated inversely with the initial ICP (p <0.01), indicating less recovery of flow when preoperative ICP was markedly elevated. On postoperative Days 1 and 2, head-of-bed elevation produced an increase in microvascular perfusion on CEU (mean 37 ± 11 compared with 51 ± 20, p <0.05) and a small decrease in ICP (mean 16 ± 5 mm Hg compared with 12 ± 4 mm Hg, p <0.05). In patients with parenchymal hematoma, CEU provided spatial information on perfusion abnormalities in the hemorrhagic core and surrounding tissues. Conclusions. Contrast-enhanced ultrasonography has potential for the intraoperative and bedside assessment of cerebral perfusion in patients with TBI. The technique may be appropriate for evaluating responses to therapies aimed at preventing secondary ischemia and for assessing regional perfusion abnormalities.

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