Preoperative and postoperative transcranial doppler sonographic evaluations of the cerebral hemodynamics of craniostenosis

Abstract

OBJECTIVES: Making use of transcranial Doppler sonographic (TCD) technology to monitor the preoperative and postoperative changes in cerebral hemodynamics of sick children with craniostenosis and to evaluate the effects brought about by decompression surgery of craniostenosis by means of various changes in the parameters of cerebral blood flow. METHODS: Choosing bilateral middle cerebral arteries as target vessels by means of TCD and recording preoperative and postoperative cerebral blood flow velocities (peak systolic [Vs] and diastolic velocities [Vd]), pulsatility index (PI), blood pressure, and pulse rate. RESULTS: Among 11 cases of children with craniostenosis, postoperative Vs and Vd of 4 children aged 0 to 3 years old increased by 20.25 (14.75) and 15.75 (12.98) cm/s, respectively (P < 0.05); PI reduced by 0.09 (0.09) (P > 0.05); finger press marks could be found in 4 skull x-ray films, and ventricular dilatation was found in one of them. Postoperative Vs and Vd of 5 children aged 4 to 7 years old increased by 16.20 (15.39) and 15.00 (11.71) cm/s, respectively (P < 0.05); PI reduced by 0.14 (0.11) (P < 0.05); one of them experienced ventricular dilatation. In 2 children aged 11 years old, postoperative Vs, Vd, and PI increased by 2.50 (5.00) and 0.500 (3.79) cm/s and 0.09 (0.09), respectively (P > 0.05). An abnormality could be found in electroencephalograms of a child with Apert syndrome and 2 children with hydrocephalus. CONCLUSIONS: Operation can improve obviously younger sick children's cerebral blood flow velocity and PI; for older children, the improvement of diastolic cerebral blood flow velocity was more obvious than that of systolic cerebral blood flow velocity, and PI reduced distinctly, which showed that decompression surgery had a perfect effect on craniostenosis. The TCD parameters of an 11-year-old sick child who has a smaller head circumference but without intracranial hypertension could not be improved obviously. Transcranial Doppler sonography can be regarded as a simple and convenient tool for the noninvasive evaluation on the effect of decompression surgery of craniostenosis. Copyright © 2010 by Mutaz B. Habal.