ISPUB.COM The Internet Journal of Anesthesiology Volume 8 Number 2 1 of 6 Use of Transcranial Cerebral Oximeter as Indicator for Bifrontal Decompressive Craniectomy S El-Watidy, A El-Dawlatly, Z Jamjoom, E El-Gamal Citation S El-Watidy, A El-Dawlatly, Z Jamjoom, E El-Gamal. Use of Transcranial Cerebral Oximeter as Indicator for Bifrontal Decompressive Craniectomy. The Internet Journal of Anesthesiology. 2003 Volume 8 Number 2. Abstract Objectives: The timing of bifrontal decompressive craniectomy (BDC) in patients with intractable intracranial hypertension (IH) is crucial, and the decision to do surgery is based primarily on invasive neuromonitoring. In this report the authors show the efficacy of a non-invasive, near infrared transcranial cerebral oximeter (TCCO) in the management of a patient with post- traumatic IH. Clinical Presentation: A 14-year-old male patient who had severe head injury following road traffic accident (RTA). His Glasgow Come Score (GCS) was 6/15. Brain computerized tomography (CT) scan showed multiple brain contusions and diffuse brain edema. He developed a state of IH that did not respond to standard medical treatment. We have used TCCO for neuromonitoring, its readings showed marked difference between the two cerebral hemispheres and this correlated well with the clinical and radiological findings. Intervention: Because of the decreasing trend of cerebral oxygen saturation and pupillary changes (anisocoria) BDC was performed. The timing of surgery was appropriate as no brain infarction occurred. Following surgery, TCCO readings were normal and the patient recovery was dramatic and relatively quick. Conclusion: TCCO may be an efficient Neuromonitoring tool in determining the time for surgical interference in patients with IH following RTA. INTRODUCTION IH is a state of severely raised intracranial pressure (ICP) which does not respond to routine medical treatment. Patients most often will die or survive with severe disability. BDC is the last resort therapy in these instances. The decision to do surgical decompression is based primarily on invasive monitoring of the ICP. TCCO using near infrared light (700-900 wavelengths) is a non-invasive neuromonitoring modality used for monitoring cerebral oxygen saturation (rSO 2 %) in head injury patients ( 1 , 2 ). The aim of this report is to shed light on the adequacy and efficacy of TCCO as a sole indicator for decompressive craniectomy in patients with post-traumatic IH. CASE REPORT A 14-year-old male patient presented to the emergency department shortly after RTA. Upon arrival, he was unconscious, spontaneously breathing (20/min), heart rate 90/minute, blood pressure 113/83 mmHg, temperature 36.7C, and tissue oxygen saturation 97%. Neurologically his Glasgow coma scale (GCS) was 9/15; his pupils were 3mm equal, and reactive to light. He has a big occipital scalp laceration and large subgaleal hematoma. Systemic review was unremarkable. Shortly after admission to the emergency department, the patient's condition worsened to GCS 6/15. The left pupil became larger than the right and both had sluggish reaction to light. Immediately, the trachea was intubated and the lungs were hyperventilated. Mannitol 20% (0.5 gm/kg i.v bolus) was administered. A CT of the brain scan showed multiple brain contusions in the cerebellum, left frontal and temporal lobes, generalized brain edema, more on the left side causing compression of the lateral and third ventricles, effacement of cerebral sulci, and encroachment on basal cisterns. (see Fig 1.)