Surgical decompression for malignant cerebral oedema after ischaemic stroke

Dower, Ashraf; Mulcahy, Michael; Maharaj, Monish; Chen, Hui; Lim, Chi Eung Danforn; Li, Yingda; Sheridan, Mark

doi:10.1002/14651858.cd014989.pub2

Cited by 13 publications

(8 citation statements)

References 33 publications

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“…Owing to limited published experience with neurosurgical management of cases of autoimmune-mediated elevated ICP, decisions relating to ICP monitor placement or initiation of medical therapies to manage ICP are mainly based on the basic principles of reducing secondary brain injury mentioned above and extrapolation from the ICP and mortality benefit described in the literature on TBI and cerebral infarction, where neurosurgical intervention has been most extensively studied. 25 , 26 In our practice, for acute diffuse intracranial processes causing a depressed neurologic examination (GCS ≤8) with signs of diffuse cerebral edema, herniation, or mass effect on imaging, placement of an ICP monitor or EVD is preferred. If the cerebral ventricles are small, an ICP transducer is implanted unless the ventricles are large enough to accurately place an EVD, which allows the therapeutic option of CSF drainage to reduce ICP.…”

Section: Discussionmentioning

confidence: 99%

Increased Intracranial Pressure in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease

Nguyen,

Miles,

Harder

et al. 2024

Neurol Neuroimmunol Neuroinflamm

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Background and ObjectivesElevated intracranial pressure (ICP) in myelin oligodendrocyte glycoprotein (MOG) antibody–associated disease (MOGAD) has been largely unexplored. The objectives of this study were to determine the frequency of increased ICP in MOGAD and its association with disease course and outcomes and to highlight cases requiring medical and/or surgical management of increased ICP.MethodsIn this retrospective, single-center cohort study, we examined the clinical and paraclinical data from the initial presentation and follow-up data of children diagnosed with MOGAD. In those with opening pressure (OP) measurements, univariate analyses were used to evaluate factors associated with increased ICP, which was defined as OP > 28 cm H2O. We also present a case series of patients with or without OP measurement who required medical and/or surgical management of increased ICP.ResultsOf 86 children with MOGAD, 43 (50.0%) had an OP recorded and 7 (8.1%) required ICP management. In those with OP recorded, the median (interquartile range) OP for the different MOGAD phenotypes were: 30.0 (22.8–41.6) (acute disseminated encephalomyelitis, ADEM), 20.5 (16.1–23.6) (optic neuritis), 17.0 (17.0–22.5) (myelitis), and 19.5 (16.5–29.3) (other) cm H20. Overall, 20.9% had increased ICP based on an OP > 28 cm H2O, of whom 77.8% presented with ADEM. In a subgroup analysis of those presenting with ADEM, those with an elevated ICP had longer hospital stay (p= 0.007) and neurologic disability (defined as modified Rankin Scale >1) (p= 0.049). In those with or without OP recorded, 7 (6 with ADEM, one with cerebral cortical encephalitis) required ICP-directed therapies. Findings on brain MRI in these 7 children revealed extensive disease burden with bilateral cerebral involvement and evidence of restricted diffusion. While neuropsychological data in this small subset revealed significant variability, all sustained identifiable deficits after discharge, including attention-deficit hyperactivity disorders and language and learning disorders.DiscussionIn pediatric MOGAD, increased OP and ADEM at initial presentation were associated with longer hospital stays and greater long-term morbidity. Although invasive ICP monitoring has not been specifically advocated in the management of MOGAD, it is important to recognize signs and symptoms of increased ICP in these patients and consider ICP monitoring and management strategies based on clinical and radiologic findings, especially in those presenting with ADEM and with OP > 28 cm H2O.

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Section: Discussionmentioning

confidence: 99%

Increased Intracranial Pressure in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease

Nguyen,

Miles,

Harder

et al. 2024

Neurol Neuroimmunol Neuroinflamm

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“…Several neurosurgeons evaluated this model accurately (measured on a 5-point Likert scale in Supplementary Figure S1 ). Unfortunately, the brain tissue will inevitably shift with the increase in the scope of the tumor resection and the redistribution of intracranial pressure ( 37 ). It can have a fatal effect on operations that rely too heavily on preoperative localization.…”

Section: Discussionmentioning

confidence: 99%

Using mixed reality technique combines multimodal imaging signatures to adjuvant glioma photodynamic therapy

Dong,

Wang,

et al. 2023

Front. Med.

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BackgroundPhotodynamic therapy (PDT) promotes significant tumor regression and extends the lifetime of patients. The actual operation of PDT often relies on the subjective judgment of experienced neurosurgeons. Patients can benefit more from precisely targeting PDT’s key operating zones.MethodsWe used magnetic resonance imaging scans and created 3D digital models of patient anatomy. Multiple images are aligned and merged in STL format. Neurosurgeons use HoloLens to import reconstructions and assist in PDT execution. Also, immunohistochemistry was used to explore the association of hyperperfusion sites in PDT of glioma with patient survival.ResultsWe constructed satisfactory 3D visualization of glioma models and accurately localized the hyperperfused areas of the tumor. Tumor tissue taken in these areas was rich in CD31, VEGFA and EGFR that were associated with poor prognosis in glioma patients. We report the first study using MR technology combined with PDT in the treatment of glioma. Based on this model, neurosurgeons can focus PDT on the hyperperfused area of the glioma. A direct benefit was expected for the patients in this treatment.ConclusionUsing the Mixed Reality technique combines multimodal imaging signatures to adjuvant glioma PDT can better exploit the vascular sealing effect of PDT on glioma.

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“…Indications include ischemic infarct resulting from stroke of the middle cerebral artery (MCA) or malignant MCA occlusion syndrome. Additionally, DHC can be performed in the setting of uncontrollable brain swelling after craniotomy has already been performed [ 1 – 3 ]. Furthermore, any cause of traumatic intracranial hypertension, including epidural (EDH), traumatic subarachnoid hemorrhage (tSAH), and/or subdural hematomas (SDH), often require emergency surgery in which decompression is warranted.…”

Section: Introductionmentioning

confidence: 99%

Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques

Brown,

Gendreau,

Rahmani

et al. 2024

Neurosurg Rev

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Decompressive hemicraniectomy (DHC) is a critical procedure used to alleviate elevated intracranial pressure (ICP) in emergent situations. It is typically performed to create space for the swelling brain and to prevent dangerous and potentially fatal increases in ICP. DHC is indicated for pathologies ranging from MCA stroke to traumatic subarachnoid hemorrhage—essentially any cause of refractory brain swelling and elevated ICPs. Scalp incisions for opening and closing the soft tissues during DHC are crucial to achieve optimal outcomes by promoting proper wound healing and minimizing surgical site infections (SSIs). Though the reverse question mark (RQM) scalp incision has gained significant traction within neurosurgical practice, alternatives—including the retroauricular (RA) and Kempe incisions—have been proposed. As choice of technique can impact postoperative outcomes and complications, we sought to compare outcomes associated with different scalp incision techniques used during DHC. We queried three databases according to PRISMA guidelines in order to identify studies comparing outcomes between the RQM versus “alternative” scalp incision techniques for DHC. Our primary outcome of interest in the present study was postoperative wound infection rates according to scalp incision type. Secondary outcomes included estimated blood loss (EBL) and operative duration. We identified seven studies eligible for inclusion in the formal meta-analysis. The traditional RQM technique shortened operative times by 36.56 min, on average. Additionally, mean EBL was significantly lower when the RQM scalp incision was used. Postoperatively, there was no significant association between DHC incision type and mean intensive care unit (ICU) length of stay (LOS), nor was there a significant difference in predisposition to developing wound complications or infections between the RQM and retroauricular/Kempe incision cohorts. Superficial temporal artery (STA) preservation and reoperation rates were collected but could not be analyzed due to insufficient number of studies reporting these outcomes. Our meta-analysis suggests that there is no significant difference between scalp incision techniques as they relate to surgical site infection and wound complications. At present, it appears that outcomes following DHC can be improved by ensuring that the bone flap is large enough to enable sufficient cerebral expansion and decompression of the temporal lobe, the latter of which is of particular importance. Although previous studies have suggested that there are several advantages to performing alternative scalp incision techniques during DHC, the present study (which is to our knowledge the first to meta-analyze the literature on outcomes in DHC by scalp incision type) does not support these findings. As such, further investigations in the form of prospective trials with high statistical power are merited.

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Surgical decompression for malignant cerebral oedema after ischaemic stroke

Cited by 13 publications

References 33 publications

Increased Intracranial Pressure in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease

Increased Intracranial Pressure in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease

Using mixed reality technique combines multimodal imaging signatures to adjuvant glioma photodynamic therapy

Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques

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