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Effect of increased ICP and decreased CPP on DND and outcome in ASAH

Krissanee Karnchanapandh1

  • 1Department of Neurosurgery, Rangsit University, Bangkok, Thailand. patarapol@hotmail.com

Acta Neurochirurgica. Supplement
|February 14, 2012
PubMed

Insights

Early clipping for aneurysmal subarachnoid hemorrhage (ASAH) can lead to increased intracranial pressure (ICP) and decreased cerebral perfusion pressure (CPP), potentially worsening neurological outcomes. While ICP elevation appears more detrimental, the study found no statistically significant relationships between these factors and patient outcomes.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Early clipping in aneurysmal subarachnoid hemorrhage (ASAH) can precipitate postoperative increases in intracranial pressure (ICP) and decreases in cerebral perfusion pressure (CPP).
  • These hemodynamic changes may contribute to the development of delayed neurological deficit (DND), irreversible neurological deficit (IRND), and poor outcomes.

Purpose of the Study:

  • To investigate the relationship between postoperative ICP and CPP and neurological outcomes in patients undergoing early clipping for ASAH.
  • To evaluate the impact of ICP and CPP on DND, IRND, and poor outcomes.

Main Methods:

  • A retrospective analysis of 30 patients with early clipping for ASAH.
  • Inclusion of postoperative ICP monitoring, flow velocity measurement, triple H-nimodipine therapy, and an ICP-CPP-oriented strategy.
  • Statistical analysis using the Chi-squared test to assess relationships between ICP, CPP, and neurological deficits.

Main Results:

  • Mean ICP was 34.2 mmHg and mean CPP was 71.3 mmHg.
  • Higher ICP levels (≥20, 30, 40 mmHg) correlated with increased incidence of DND (58.3%, 58.8%, 70%) and poor outcomes (37.5%, 41.1%, 40%).
  • Lower CPP levels (≤80, 70, 60 mmHg) also correlated with increased DND (64.7%, 63.3%, 80%) and poor outcomes (41.1%, 27.2%, 40%).
  • Statistical analysis did not reveal significant relationships between ICP, CPP, and neurological outcomes.

Conclusions:

  • Postoperative increased ICP is common after early clipping, particularly in poor-grade ASAH patients.
  • Decreased CPP was less frequent, potentially due to aggressive management strategies.
  • Elevated ICP appears more detrimental than decreased CPP, acting as a secondary insult that may negatively impact neurological function.
Abstract

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