Cerebral microdialysis and P(ti)O2 for neuro-monitoring before decompressive craniectomy

We report the case of a young patient with post-traumatic, intractable, intracranial hypertension leading to craniectomy. This intracranial hypertension was preceded by focal signs of ischemia diagnosed through P(ti)O2 monitoring and cerebral microdialysis, and occurred a few hours prior to a decrease in cerebral perfusion pressure below 60 mmHg. The neurological outcome was satisfactory with a Glasgow Outcome Scale of 4 at 3 months. We discuss the potential interest of such neuro-monitoring to determine the optimal time for performing a craniectomy.