{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T07:53:22Z","timestamp":1770537202490,"version":"3.49.0"},"reference-count":55,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2006,1]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The use of decompressive craniectomy has experienced a revival in the previous decade, although its actual benefit on patients\u2019 neurological outcome remains the subject of debate. A better understanding of the intracranial pressure dynamics, as well as of the metabolic and hemodynamic brain processes, may be useful in assessing the effect of this surgery on the pathophysiology of the swollen brain. The aim of this study was to use transcranial Doppler (TCD) ultrasonography to examine the hemodynamic changes in the brain after decompressive craniectomy in patients with head injury, in addition to examining the relationship between such hemodynamic changes and the patient\u2019s neurological outcome.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Nineteen patients presenting with traumatic brain swelling and cerebral herniation syndrome who had undergone decompressive craniectomy with dural expansion were studied prospectively. The TCD ultrasonography measurements were performed bilaterally in both the middle cerebral artery (MCA) and in the distal portion of the cervical internal carotid artery (ICA) immediately prior to and after surgical decompression.<\/jats:p>\n<jats:p>After surgery, the mean blood flow velocity (BFV) rose to 175 \u00b1 209% of preoperative values in the MCA of the operated side, while rising to 132 \u00b1 183% in the contralateral side; the difference between the mean BFV increase in in the MCA of both the decompressed and the opposite side reached statistical significance (p &lt; 0.05). The mean BFV of the extracranial ICA increased to 91 \u00b1 119% in the surgical side and 45 \u00b1 60% in the opposite side. Conversely, the MCA pulsatility index (PI) values decreased, on average, to 33 \u00b1 36% of the preoperative value in the operated side and to 30 \u00b1 34% on the opposite side; the MCA PI value reductions were significantly greater in the decompressed side when compared with the contralateral side (p &lt; 0.05). The PI of the extracranial ICA reduced, on average, to 37 \u00b1 23% of the initial values in the operated side and to 24 \u00b1 34%, contralaterally. No correlation was verified between the neurological outcome and cerebral hemodynamic changes seen on TCD ultrasonography.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Decompressive craniectomy results in a significant elevation of cerebral BFV in most patients with traumatic brain swelling and transtentorial herniation syndrome. The increase in cerebral BFV may also occur in the side opposite the decompressed hemisphere; the cerebral BFV increase is significantly greater in the operated hemisphere than contralaterally. Concomitantly, PI values decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance.<\/jats:p><\/jats:sec>","DOI":"10.3171\/jns.2006.104.1.93","type":"journal-article","created":{"date-parts":[[2008,1,24]],"date-time":"2008-01-24T12:28:14Z","timestamp":1201177694000},"page":"93-100","source":"Crossref","is-referenced-by-count":79,"title":["Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression"],"prefix":"10.3171","volume":"104","author":[{"given":"Edson","family":"Bor-Seng-Shu","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Hospital das Cl\u00ednicas, S\u00e3o Paulo University Medical School, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, 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