Long-Term Effect of Decompressive Craniectomy on Intracranial Pressure and Possible Implications for Intracranial Fluid Movements
| Autor: | Marianne Juhler, Trine Hjorslev Andreasen, Jesper Kelsen, Alexander Lilja-Cyron, Kåre Fugleholm, Morten Andresen |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Decompressive Craniectomy Supine position Intracranial Pressure Traumatic brain injury medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid Germany Brain Injuries Traumatic Humans Medicine Prospective Studies Stroke Aged Monitoring Physiologic Intracranial pressure business.industry musculoskeletal neural and ocular physiology Prostheses and Implants Middle Aged medicine.disease nervous system diseases Hydrocephalus Intensive Care Units 030220 oncology & carcinogenesis Anesthesia Intracranial pressure monitoring Female Surgery Decompressive craniectomy Neurology (clinical) Intracranial Hypertension business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Neurosurgery. 86:231-240 |
| ISSN: | 1524-4040 0148-396X |
| DOI: | 10.1093/neuros/nyz049 |
| Popis: | Background Decompressive craniectomy (DC) is used in cases of severe intracranial hypertension or impending intracranial herniation. DC effectively lowers intracranial pressure (ICP) but carries a risk of severe complications related to abnormal ICP and/or cerebrospinal fluid (CSF) circulation, eg, hygroma formation, hydrocephalus, and "syndrome of the trephined." Objective To study the long-term effect of DC on ICP, postural ICP regulation, and intracranial pulse wave amplitude (PWA). Methods Prospective observational study including patients undergoing DC during a 12-mo period. Telemetric ICP sensors (Neurovent-P-tel; Raumedic, Helmbrechts, Germany) were implanted in all patients. Following discharge from the neuro intensive care unit (NICU), scheduled weekly ICP monitoring sessions were performed during the rehabilitation phase. Results A total of 16 patients (traumatic brain injury: 7, stroke: 9) were included (median age: 55 yr, range: 19-71 yr). Median time from NICU discharge to cranioplasty was 48 d (range: 16-98 d) and during this period, mean ICP gradually decreased from 7.8 ± 2.0 mm Hg to -1.8 ± 3.3 mm Hg (P = .02). The most pronounced decrease occurred during the first month. Normal postural ICP change was abolished after DC for the entire follow-up period, ie, there was no difference between ICP in supine and sitting position (P = .67). PWA was markedly reduced and decreased from initially 1.2 ± 0.7 mm Hg to 0.4 ± 0.3 mm Hg (P = .05). Conclusion Following NICU discharge, ICP decreases to negative values within 4 wk, normal postural ICP regulation is lost and intracranial PWA is diminished significantly. These abnormalities might have implications for intracranial fluid movements (eg, CSF and/or glymphatic flow) following DC and warrants further investigations. |
| Databáze: | OpenAIRE |
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