To explore the clinical effect and prognosis prediction of the combination of transcranial Doppler (TCD) and ventricular invasive intracranial pressure (ICP) monitoring in the treatment of post-traumatic acute bilateral cerebral hemisphere diffuse brain swelling (PADBS) patients.

Forty-two PADBS patients who admitted to Second Department of Neurosurgery, the 98th Hospital of Chinese People's Liberation Army from March 2013 to December 2015 were enrolled in this retrospective study. They all accepted TCD and ventricular ICP monitoring within 2 h after admission. According to the initial ICP, patients were divided into the ICP ≤ 25 mmHg group (27 cases) and ICP> 25 mmHg group (15 cases). In addition, according to the brain pulsatility index (PI) detected by initial TCD after admission, patients were divided into the PI ≤ 1.4 group (18 cases) and PI> 1.4 (24 cases). Clinical outcome was determined based on the Glasgow outcome scale (GOS) 6 months after injury. The prognosis were compared between the different ICP groups and PI groups.

The initial ICP of PADBS patients were 15-46 mmHg (mean: 24 ± 7 mmHg) after admission, and the initial PI were 1.21-3.31 (mean: 1.7 ± 0.5). Twenty cases recovered well, 14 cases had moderate disability, 3 cases had severe disability, 3 cases were at persistent vegetative state and 2 cases died. Twenty-five patients in the ICP ≤ 25 mmHg group and 9 patients in the ICP> 25 mmHg group recovered well. More patients in the ICP ≤ 25 mmHg group recovered well as compared with the ICP> 25 mmHg group [92.59% (25/27) vs. 60.00% (15/25), χ² = 4.695, P< 0.05]. Fifteen patients in the PI ≤ 1.4 group and 19 patients in the PI> 1.4 group recovered well [83.33% (15/18) vs. 79.16% (19/24), χ² = 0.003, P> 0.05].

The combination of TCD and ventricular invasive ICP monitoring could guide the clinical treatment for PADBS patients, and also help to predict the prognosis. The PADBS patients, with the initial ICP ≤ 25 mmHg at admission, generally had a better prognosis.