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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBOR-SENG-SHU, Edson
dc.contributor.authorDE-LIMA-OLIVEIRA, Marcelo
dc.contributor.authorNOGUEIRA, Ricardo Carvalho
dc.contributor.authorALMEIDA, Kelson James
dc.contributor.authorPASCHOAL, Eric Homero Albuquerque
dc.contributor.authorPASCHOAL JR., Fernando Mendes
dc.identifier.citationFRONTIERS IN NEUROLOGY, v.10, article ID 354, 7p, 2019
dc.description.abstractBackground: There are no studies describing the cerebral hemodynamic patterns that can occur in traumatic brain injury (TBI) patients following decompressive craniectomy (DC). Such data have potentially clinical importance for guiding the treatment. The objective of this study was to investigate the postoperative cerebral hemodynamic patterns, using transcranial Doppler (TCD) ultrasonography, in patients who underwent DC. The relationship between the cerebral circulatory patterns and the patients' outcome was also analyzed. Methods: Nineteen TBI patients with uncontrolled brain swelling were prospectively studied. Cerebral blood circulation was evaluated by TCD ultrasonography. Patients and their cerebral hemispheres were categorized based on TCD-hemodynamic patterns. The data were correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Results: Different cerebral hemodynamic patterns were observed. One patient (5.3%) presented with cerebral oligoemia, 4 patients (21%) with cerebral hyperemia, and 3 patients (15.8%) with cerebral vasospasm. One patient (5.3%) had hyperemia in one cerebral hemisphere and vasospasm in the other hemisphere. Ten patients (52.6%) had nonspecific circulatory pattern. Abnormal TCD-circulatory patterns were found in 9 patients (47.4%). There was no association between TCD-cerebral hemodynamic findings and outcome. Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient.eng
dc.publisherFRONTIERS MEDIA SAeng
dc.relation.ispartofFrontiers in Neurology
dc.subjectdecompressive craniectomyeng
dc.subjecttraumatic brain injuryeng
dc.subjecttranscranial Doppler ultrasonographyeng
dc.subjectintracranial pressure (ICP)eng
dc.subjectcerebral hemodynamicseng
dc.subject.othertranscranial dopplereng
dc.titleDecompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluationeng
dc.rights.holderCopyright FRONTIERS MEDIA SAeng
dc.subject.wosClinical Neurologyeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng, Kelson James:Univ Fed Piaui, Med Sch, Dept Neurol, Teresina, Brazil, Eric Homero Albuquerque:Fed Univ Para, Med Sch, Dept Neurol, Sao Paulo, Brazil
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Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - LIM/26
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental

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