Artikel
The value of transcranial duplex sonography in determining the indication of decompressive craniectomy in patients with acute hemispheric stroke
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Autoren
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I. Fiss
- Neurochirurgische Klinik, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: Transcranial color-coded duplex sonography (TCCS) is a non-invasive method for bedside evaluation of cranial parenchyma. It yields reliable information regarding the midline shift in massive hemispheric infarctions by evaluation of lateral displacement of the third ventricle.The author studied the prognostic value of sonographic monitoring of the midline shift in acute hemispheric stroke for identifying patients who would benefit from early decompressive craniectomy.
Methods: Forty-six (46) patients with acute, massive territorial infarction in the supplying area of the middle cerebral artery were investigated 10±3, 32±4, 57±5, 72±5 and 82±5 hours after the onset of symptoms. On admission, each patient received a cerebral computed tomography, and an extracranial duplex sonographic examination was performed. The distance from the sonographic probe to the centre of the third ventricle was measured both from the symptomatic (A) and the asymptomatic (B) side. Midline shift (MS) was calculated using the formula: MS = (A-B)/2. The size of the infarction, and midline shift were determined by computed tomography as the reference method.
Results: Twelve patients died due to transtentorial herniation (group 2), and 32 patients survived (group 1). Two patients survived after decompressive hemicraniectomy 27 and 30 hours after onset of symptoms, respectively. Midline shift at 32 hours after symptom onset was significantly larger in group 2 than in group 1. Specificity and sensitivity as well as the predictive value for death due to transtentorial herniation were 1.0 with a midline shift of >4.0mm/>5.0mm/>6.0mm and >7.0mm at 32, 57, 72, and 82 hours after onset of symptoms.
Conclusions: Due to its non-invasive character and the possibility of tight-meshed bedside monitoring, TCCS is well suited for course evaluations regarding the midline shift of stroke patients with massive hemispheric infarction and may be a helpful tool in efficiently determining the indication of early decompressive craniectomy to improve outcome (death vs. survival as well as functional outcome).
