Application of multimodal ultrasound in large craniotomy for patients with severe traumatic brain injury: research progress / 中华创伤杂志

ABSTRACT

With the progression of primary and secondary brain injury, as well as the increase of the intracranial pressure, severe traumatic brain injury (sTBI) patients, if not timely and effective treated, will lead to brain hernia or even central failure. Therefore, sTBI patients often require emergency surgical intervention, including large craniotomy or even decompression. However, postural changes, brain tissue pulling and loss of cerebrospinal fluid can cause "brain drift" in sTBI patients. Meanwhile, improper rapid decompression will result in brain tissue displacement or delayed hematoma, which makes the intracranial condition deviated from the preoperative image data, even leads to deterioration. The application of multimodal intraoperative ultrasound can simply, intuitively visualize the intracranial lesion, blood flow and microperfusion in a real-time manner, guiding the surgeon to preserve the normal brain tissue to the maximum extent and improving the prognosis of the patients with the appropriate operation plan. Over the last few decades, the application of multimodal ultrasound in large craniotomy in patients with sTBI was mainly to identify intracranial lesions while there were few studies on the evaluation of cerebral hemodynamic heterogeneity of sTBI. To this end, the authors reviewed the imaging characteristics of various examination techniques of multimodal ultrasound and the progress of its application in sTBI surgery, hoping to provide evidences for accurate intraoperative evaluation and adjustment of treatment plan.