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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5813_Библиотеки_им_академика_М_И_Перельмана.pdf
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29 Case 5: Intracranial Hypertension andDecompressive Craniectomy inSevere aSAH
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Fig. 29.4 (a–d) Cerebral ultrasound view of a decompressed brain
Fig. 29.5 (a, b) Cerebral ultrasound view and color Doppler of vessels in a decompressed brain
Fig. 29.6 (a–b) Increased blood ow velocity detected with TCCD in both ACA and MCA
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Fig. 29.7 (a–h) DSA image frames during baloon angioplasty (ACA and MCA) procedure
R. Bertuetti et al.
Fig. 29.8 (a–d) TCCD ow velocities after cerebral angioplastic procedure
29 Case 5: Intracranial Hypertension andDecompressive Craniectomy inSevere aSAH
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Fig. 29.9 (a–n) Resolving HCP monitored with the help of brain ultrasound: on the left lateral ventricle size measured
on CT head images compared with corresponding ventricles size estimated with brain ultrasound
Case 6: Brain Ultrasound
forEVD Weaning
RitaBertuetti, MaurizioSaini, DavideSavo,
FrancescaSimonassi, KartikaChandrapatham,
andTarekSenussi
30
46-Year-old woman was admitted to ICU for
right parietal intracranial haematoma associated to massive intraventricular haemorrhage
(IVH) secondary to arterioventricular malformation (AVM) rupture (Fig.30.1a–d). Because
of IVH, external ventricular drainage (EVD)
R. Bertuetti (*)
Department of Anesthesiology, Critical Care
Medicine and Emergency, Division of Neurocritical
Care, ASST Spedali Civili di Brescia, University
Hospital, Brescia, Italy
M. Saini · D. Savo
Department of Emergency, Perioperative Medicine
and Intensive Care, Neuroanesthesia and
Neurointensive Care Unit, San Gerardo Hospital,
ASST-Monza, Monza, Italy
F. Simonassi · K. Chandrapatham
Anesthesia and Intensive Care, Ospedale Policlinico
San Martino– IRCCS for Oncology and
Neurosciences, Genoa, Italy
T. Senussi
Department of Surgical Sciences and Integrated
Diagnostics, University of Genoa, Genoa, Italy
was inserted and thereafter the AVM was
secured (Fig. 30.2a–d). In the following days
resolution of the hydrocephalus and IVH was
followed up by means of ultrasound with serial
measurements of ventricle size (Figs.30.3a–c,
30.4a–c, 30.5a–c).
© Springer Nature Switzerland AG 2021
C. Robba, G. Citerio (eds.), Echography and Doppler of the Brain,
https://doi.org/10.1007/978-3-030-48202-2_30
309
310
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R. Bertuetti et al.
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Fig. 30.1 (a–d) Head CT scan frames showing IVH and angio CT showing right temporo-parietal AVM
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Fig. 30.2 (a–d) DSA (density subtraction angiography) images during AVM closure procedure
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Fig. 30.3 (a–c) Lateral ventricles size measured on CT head (left and middle panels) and with brain ultrasound
(right panel)
30 Case 6: Brain Ultrasound forEVD Weaning
311
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Fig. 30.4 (a–c) Lateral ventricles size measured on CT head (left and middle panels) and with brain ultrasound
(right panel)
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Fig. 30.5 (a–c) Lateral ventricles size measured on CT head (left and middle panels) and with brain ultrasound
(right panel)
Case 7: Posterior Cranial Fossa
Brain Tumor inaPediatric Patient
RitaBertuetti, MaurizioSaini, DavideSavo,
FrancescaSimonassi, KartikaChandrapatham,
andTarekSenussi
31
A 2-year-old child, admitted to ICU for hydrocephalus secondary to posterior fossa tumor
(Fig.31.1a–d), was weaned from EVD after surgical resection of the tumor: thanks to the good
correlation between brain ultrasound and head
R. Bertuetti (*)
Department of Anesthesiology, Critical Care
Medicine and Emergency, Division of Neurocritical
Care, ASST Spedali Civili di Brescia, University
Hospital, Brescia, Italy
M. Saini · D. Savo
Department of Emergency, Perioperative Medicine
and Intensive Care, Neuroanesthesia and
Neurointensive Care Unit, San Gerardo Hospital,
ASST-Monza, Monza, Italy
F. Simonassi · K. Chandrapatham
Anesthesia and Intensive Care, Ospedale Policlinico
San Martino– IRCCS for Oncology and
Neurosciences, Genoa, Italy
T. Senussi
Department of Surgical Sciences and Integrated
Diagnostics, University of Genoa, Genoa, Italy
CT in the measurement of the ventricle size
(Figs. 31.2a–c, 31.3a–c, 31.4a–c and 31.5a–c),
clinicians could reduce the number of routine CT
scans needed to monitor the resolution of the
hydrocephalus.
© Springer Nature Switzerland AG 2021
C. Robba, G. Citerio (eds.), Echography and Doppler of the Brain,
https://doi.org/10.1007/978-3-030-48202-2_31
313
314
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R. Bertuetti et al.
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Fig. 31.1 (a–d) Pre operative MRI showing posterior fossa tumor and associated obstructive hydrocephalus
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Fig. 31.2 (a–c) Ventricles size measured on CT head and on brain ultrasound
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Fig. 31.3 (a–c) Ventricles size measured on CT head and on brain ultrasound
31 Case 7: Posterior Cranial Fossa Brain Tumor inaPediatric Patient
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Fig. 31.4 (a–c) Ventricles size measured on CT head and on brain ultrasound
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315
Fig. 31.5 (a–c) Ventricles size measured on CT head and on brain ultrasound
Case 8: Cerebral Circulatory Arrest
RitaBertuetti, MaurizioSaini, DavideSavo,
FrancescaSimonassi, KartikaChandrapatham,
andTarekSenussi
32
49-Year-old lady, rescued at home for loss of consciousness, was found by the ambulance team in
cardiac arrest (no ow time of 13min) with pulseless activity (PEA) rhythm, ACLS (advanced cardiac life support) was started, and ROSC (return
of spontaneous circulation) was achieved after
17min since the event—4min after the arrival of
the rescue team. Once in A&E, since neither the
ECG nor the ECHO showed signs of myocardial
ischemia; a brain CT angio was performed; this
showed aneurysmal subarachnoid hemorrhage
(aSAH) Fisher 3 grade, aneurysm of the internal
carotid artery, sulcal and basal cistern effacement,
and signs of cerebral hypoperfusion. The patient
was then admitted to ICU, where a neurological
evaluation was attempted after stopping sedation:
R. Bertuetti (*)
Department of Anesthesiology, Critical Care
Medicine and Emergency, Division of Neurocritical
Care, ASST Spedali Civili di Brescia, University
Hospital, Brescia, Italy
M. Saini · D. Savo
Department of Emergency, Perioperative Medicine
and Intensive Care, Neuroanesthesia and
Neurointensive Care Unit, San Gerardo Hospital,
ASST-Monza, Monza, Italy
F. Simonassi · K. Chandrapatham
Anesthesia and Intensive Care, Ospedale Policlinico
San Martino– IRCCS for Oncology and
Neurosciences, Genoa, Italy
T. Senussi
Department of Surgical Sciences and Integrated
Diagnostics, University of Genoa, Genoa, Italy
© Springer Nature Switzerland AG 2021
C. Robba, G. Citerio (eds.), Echography and Doppler of the Brain,
https://doi.org/10.1007/978-3-030-48202-2_32
GCS 3 with dilated pupils; simultanously, TCCD
showed oscillatory reverse ow consistent with
cerebral circulatory arrest (Fig.32.1).
Since the clinical course (prolonged no-ow
time, poor neurology), the brain CT showing
brain swelling, and the TCCD proving cerebral
circulatory arrest the patient was deemed unsalvageable. After few hours later the medical board
for the diagnosis of brain death was summoned,
and after the 6-h observation time according to
the Italian law, organ donation was performed.
Fig. 32.1 Reverse oscillatory ow at MCA TCCD
insonation
317