Effect of combination invasive intracranial pressure (ICP) monitoring and transcranial Doppler in the treatment of severe craniocerebral injury patients with decompressive craniectomy

Abstract

Background: The aim of the present study was to explore the clinical effect and to predict the prognosis of severe craniocerebral injury patients with decompressive craniectomy by combining transcranial Doppler (TCD) and invasive intracranial pressure (ICP).

Methods: A total of 60 severe craniocerebral injury patients with decompressive craniectomy, who were admitted to Shantou Central Hospital from June 2017 to March 2019, were enrolled in this retrospective study. Of these, 25 patients who had a Glasgow Coma Scale (GCS) score no greater 8 and no less than 6 underwent transcranial Doppler (TCD) before decompressive craniectomy, as well as ICP, after removing the skull and suturing the dura mater. The 60 patients were divided into 2 groups according to the following standards: (I) GCS score ≥8 on the 7th day postoperatively; (II) ICP continuously lower than 25 mmHg for the entire 7-day duration postoperatively; and (III) brain tissue consistently offset from the skull surface by 5 mm. The clinical outcome was determined based on the Glasgow Outcome Scale (GOS) 1, 3, and 6 months postoperatively. The TCD value, ICP, and prognosis were compared between the 2 groups.

Results: The average postoperative ICP <19 mmHg in the first 24 h, mean blood flow velocity >56.33 cm/s, end-diastolic blood flow velocity >40.28 cm/s, and resistance index <0.57 were statistically significant indicators to predict good prognosis .

Conclusions: The use of TCD can predict the prognosis of severe craniocerebral injury patients.

Keywords: Glasgow Outcome Scale (GOS); Invasive intracranial pressure (ICP); cranioplasty; decompressive craniectomy; transcranial Doppler (TCD).