Journal of Nuclear Medicine Radiology & Radiation Therapy Category: Medical Type: Editorial
Neuroimaging in Decompressive Craniectomy in Traumatic Brain Injury
- Fatima N1*
- 1 Department Of Neurosurgery, School Of Medicine, Stanford University, 450 Serra Mall, Palo Alto, California, United States
*Corresponding Author:Fatima N
Department Of Neurosurgery, School Of Medicine, Stanford University, 450 Serra Mall, Palo Alto, California, United States
Received Date: May 06, 2019 Accepted Date: May 08, 2019 Published Date: May 15, 2019
Intracranial pressure elevation and ultimately reduction in the cerebral perfusion pressure is the pathophysiological mechanism that occurs following head trauma. This would successively cause detrimental effects on cerebral oxygen metabolism and can lead to catastrophic events [1-3]. In addition, brain edema is an independent prognostic factor in traumatic brain injury with a mortality of over 10 times in patients with documented brain edema .
Therefore, Decompressive Craniectomy (DC) is considered to provide instantaneous and definitive relief of raised Intracranial Pressure ICP [5,6]. In most of the cases, DC is performed following the protocol for the treatment of refractory intracranial edema and hypertension as a secondary procedure (Secondary Decompressive Craniectomy) [7,8]. Timing of the DC (early vs. late option) plays an important role as it may change the pathophysiological responses. It is reported that the right time for DC is by clinical follow up, repeated CT scans, and continuous ICP and CPP monitoring [9,10].
CT scan is relatively cost-effective imaging modality, compatible with life support and monitors instrumentation surgical clips and implants and suitable in trauma settings that can be performed in the early postoperative period to detect potential complications. Although it has been perceived that the extra-axial collection is difficult to detect because of the artifact caused by the overlying calvarium, this issue has been resolved using multidector state of the art CT technology. Magnetic Resonance Imaging MRI which is more sensitive than CT in the postoperative period, however its use is contraindicated due to MRI incompatibility with life support or surgical applied instrumentation .
The objective of this editorial review was to examine the role of pre- and post-operative CT scan findings in patients with severe closed head injury who underwent DC. Thus, determining the correlation of radiographic features in predicting clinical outcome of patients at 6-months of clinical follow up.
Traumatic brain injury is a leading cause of morbidity and mortality. It is considered that cerebral contusion after trauma induces the life-threatening brain swelling within 2-3 hours. Second peak of brain swelling occurs within 2-5 days due to blood cell breakdown products and activated inflammatory cascades. So, surgery should be performed as soon as possible, not after 5 days of occurrence [1,8]. The neurological assessment of patients in postoperative period can be altered due to sedation, intubation and ventilation. Therefore, CT scan is considered to be an important tool in determining the clinical status of patients.
DIAGNOSTIC EFFICACY OF POST-OPERATIVE CT SCANS
Whereas in the chronic management of head injury, neuroimaging through CT scan helps in identifying the post-operative changes in the neurophysiology by alteration in the cerebral blood flow and cerebrospinal fluid, therapies to prevent the secondary brain damage, long-term prognosis of the patients [12,13]. This provides information for a multi-disciplinary approach toward management of patients with severe head trauma.
COMPLICATIONS FOLLOWING DECOMPRESSIVE CRANIECTOMY
XJ Yang et al  found that after decompressive craniectomy in patients with traumatic brain injury, the incidence of shunt dependent hydrocephalus, sub dural fluid collection, and CSF leakage from the scalp incision has increased tremendously. Scalp swelling in the early post-operative period is the most common finding as it is composed of edematous fluid, hemorrhage, cerebrospinal fluid (CSF) and air, in different amounts. It resolves over several weeks .
Expansion of hemorrhagic contusions
Post-operative sub dural effusion
External cerebral herniation
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Citation:Fatima N (2019) Neuroimaging in Decompressive Craniectomy in Traumatic Brain Injury. J Nucl Med Radiol Radiat Ther 4: 012.
Copyright: © 2019 Fatima N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.