Traumatic angiospasm as one of the criteria when choosing surgical treatment tactics. Clinical case and literature review

Posttraumatic angiospasm is one of the complications of traumatic brain injury. The pathogenesis of traumatic angiospasm includes the occurrence of vasoconstriction of cerebral vessels as a result of a reaction to hemoglobin breakdown products (an inflammatory reaction in response to subarachnoid hemorrhage (SAH)), leading to cerebral edema, ischemia and intracranial hypertension, which may affect treatment tactics. however, at the moment there are no generally accepted recommendations for the treatment of this complication.

THE PURPOSE OF THE STUDY: to assess the need for transcranial duplex scanning (TCDS) in the preoperative period in patients with traumatic brain injury to determine the optimal tactics of surgical treatment.

MATERIALS AND METHODS: An analysis of the diagnosis and treatment of 34 victims with TBI who were at the N.V. Sklifosovsky Research Institute for Emergency medicine was carried out. All patients underwent brain CT and transcranial duplex scanning (TCDS). Surgery was performed in 9 patients. The victims who underwent surgical treatment were divided into 2 groups: In 3 out of 9 patients, TCDS was performed before surgery (group 1), in 6 out of 9 patients, TCDS was performed in the postoperative period (group 2).

RESULTS: Angiospasm was detected in 15 out of 34 (44 %) according to TCDS data. Angiospasm was detected in 2 out of 3 people on TCS performed before surgery. In patients who underwent TCS in the postoperative period, angiospasm was detected in 3 out of 6 patients. Surgery was not performed on 10 patients. Patients from group 1 underwent: 1 — decompressive cranial trepanation (DCTCH), 2 — bone-plastic cranial trepanation (CRTCH) (1 subsequently, repeated intervention with DCTCh was required due to the developed edema-ischemia on the background of angiospasm). Surgical tactics were applied to patients from group 2: 2 — DCTCH, 4 — CPTCH (2 subsequently required repeated intervention — DCTCH due to the developed edema-ischemia on the background of angiospasm). In the postoperative period, deaths were 4: 3 — after preventive CT, 1 — after CT with repeated intervention in the form of DCT due to the developed edemaischemia on the background of angiospasm.

CONCLUSION: Angiospasm is a significant factor in the development of edema and ischemia of the brain. It is necessary to monitor all victims with TBI, in order to improve the outcome of the disease.

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