Invasive Monitoring of Intracranial Pressure After Decompressive Craniectomy in Malignant Stroke

Hernández-Durán, Silvia; Meinen, Leonie; Rohde, Veit

doi:10.1161/strokeaha.120.032390

Cited by 14 publications

(9 citation statements)

References 16 publications

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“…Hence, despite both thresholds of 7 and 11 mmHg are traditionally considered “low-normal”, if not attained, the likelihood of the progressive swelling leading to difficulties in controlling ICP at its peak, around day two to five after stroke ( 49 , 50 ), is substantial. Furthermore, there is some evidence that the postoperative target for malignant cerebral infarctions should be lower than the 20 mmHg commonly used in traumatic brain injuries ( 37 , 51 , 52 ), further lending credence to the notion that a lower ICP target should be the goal. In addition, the similar rates of re-operation and syndrome of the trephine amongst both groups demonstrates that further decompression to “low-normal” ICP targets is safe and well tolerated by patients.…”

Section: Discussionmentioning

confidence: 94%

Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study

et al. 2022

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BackgroundDecompressive craniectomy (DC) improves the survival and functional outcomes in patients with malignant cerebral infarction. Currently, there are no objective intraoperative markers that indicates adequate decompression. We hypothesise that closure intracranial pressure (ICP) correlates with postoperative outcomes.MethodsThis is a multicentre retrospective review of all 75 DCs performed for malignant cerebral infarction. The patients were divided into inadequate ICP (iICP) and good ICP (gICP) groups based on a suitable ICP threshold determined with tiered receiver operating characteristic and association analysis. Multivariable logistic regression was performed for various postoperative outcomes.ResultsAn ICP threshold of 7 mmHg was determined, with 36 patients (48.0%) and 39 patients (52.0%) in the iICP and gICP group, respectively. After adjustment, postoperative osmotherapy usage was more likely in the iICP group (OR 6.32, p = 0.003), and when given, was given for a longer median duration (iICP, 4 days; gICP, 1 day, p = 0.003). There was no difference in complications amongst both groups. When an ICP threshold of 11 mmHg was applied, there was significant difference in the duration on ventilator (ICP ≥11 mmHg, 3–9 days, ICP <11 mmHg, 3–5 days, p = 0.023).ConclusionSurgical decompression works complementarily with postoperative medical therapy to manage progressive cerebral edema in malignant cerebral infarctions. This is a retrospective study which showed that closure ICP, a novel objective intraoperative biomarker, is able to guide the adequacy of DC in this condition. Various surgical manoeuvres can be performed to ensure that this surgical aim is accomplished.

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Section: Discussionmentioning

confidence: 94%

Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study

et al. 2022

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“…Certainly, future research studies should aim to investigate the neurological sequelae of external pressure on the unprotected brain. In the acute setting, ICP monitoring would be a valuable outcome measure that is already widely used for these patients ( 11 , 12 ). Correlation of ICP at the time of observed craniectomy site contact in a prospective study would provide a truer estimation of transmitted interface pressure.…”

Section: Resultsmentioning

confidence: 99%

The Need for Head Protection Protocols for Craniectomy Patients during Rest, Transfers and Turning

Pandit

Singhal²,

Khawari

et al. 2022

Front. Surg.

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After craniectomy, patients are generally advised to wear a helmet when mobilising to protect the unshielded brain from damage. However, there exists limited guidance regarding head protection for patients at rest and when being transferred or turned. Here, we emphasise the need for such protocols and utilise evidence from several sources to affirm our viewpoint. A literature search was first performed using MEDLINE and EMBASE, looking for published material relating to head protection for patients post-craniectomy during rest, transfer or turning. No articles were identified using a wide-ranging search strategy. Next, we surveyed and interviewed staff and patients from our neurosurgical centre to ascertain how often their craniectomy site was exposed to external pressure and the precautions taken to prevent this. 59% of patients admitted resting in contact with the craniectomy site, in agreement with the observations of 67% of staff. In 63% of these patients, this occurred on a daily basis and for some, was associated with symptoms suggestive of raised intracranial pressure. 44% of staff did not use a method to prevent craniectomy site contact while 65% utilised no additional precautions during transfer or turning. 63% of patients received no information about avoiding craniectomy site contact upon discharge, and almost all surveyed wished for resting head protection if it were available. We argue that pragmatic guidelines are needed and that our results support this perspective. As such, we offer a simple, practical protocol which can be adopted and iteratively improved as further evidence becomes available in this area.

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“…Sang beom Jeon et al [ 18 ] analyzed the changes of ICP within 24 hours after DC, they concluded that early evaluation of ICP changes and effective intervention can improve the prognosis of patients. Silvia Hern á ndez dur á n et al [ 19 ] concluded that a threshold of 10 mmHg within the first 72 positive hours was a reliable predictor of mortality in MCI, with an acceptable sensitivity of 70% and high specificity of 97%. However, at present, there are few studies on the changes of ICP within 1 week after DC.…”

Section: Discussionmentioning

confidence: 99%

Decompressive craniectomy combined with temporal pole resection in the treatment of massive cerebral infarction

Lü¹,

Dong²,

Qin³

2022

BMC Neurol

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Objective To evaluate the efficacy and prognosis of decompressive craniectomy combined with temporal pole resection in the treatment of massive cerebral infarction, in order to provide basis for treatment selection. Methods The clinical data of the patient with massive cerebral infarction treated in our hospital from January 2015 to December 2018 were analyzed retrospectively. According to the surgical methods, the patients were divided into control group (decompressive craniectomy) and study group (decompressive craniectomy + temporal pole resection). Intracranial pressure monitoring devices were placed in both groups. The NIHSS scores of the two groups before and 14 days after operation, the changes of intracranial pressure, length of hospital stay, length of NICU, mortality and modified Rankin scale before and after treatment were compared between the two groups. Results The NIHSS score of the two groups after operation was lower than that before operation, and the NIHSS score of the study group was significantly lower than that of the control group (P < 0.05); The intracranial pressure in the study group was significantly lower than that in the control group (P < 0.05); One month after operation, the mortality of the study group (13.0%) was lower than that of the control group (27.8%). After one year of follow-up, the mortality of the study group (21.7%) was significantly lower than that of the control group (38.8%) (P < 0.05); The scores of mRS in the two groups were significantly improved compared with those before treatment (P < 0.05), and the scores of mRS in the study group were better than those in the control group (P < 0.05). Conclusion Decompressive craniectomy combined with temporal pole resection has a better effect in the treatment of patients with massive cerebral infarction. It has good decompression effect, the postoperative intracranial pressure is well controlled, and significantly reduced the mortality. So it has better clinical application value.

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Invasive Monitoring of Intracranial Pressure After Decompressive Craniectomy in Malignant Stroke

Cited by 14 publications

References 16 publications

Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study

Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study

The Need for Head Protection Protocols for Craniectomy Patients during Rest, Transfers and Turning

Decompressive craniectomy combined with temporal pole resection in the treatment of massive cerebral infarction

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