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Published on: October 15, 2021
Compare the Intracranial Pressure Trend after the Decompressive Craniectomy between Massive Intracerebral Hemorrhagic
Joon Huh1, Seo-Yeon Yang2, Han-Yong Huh3
1Department of Neurosurgery, Myungji St. Mary's Hospital, Seoul, Korea.
Insights
Decompression craniectomy (DC) effectively lowers intracranial pressure (ICP) in intracerebral hemorrhage (ICH) patients when significant hematoma removal is achieved. However, DC shows less ICP reduction in major infarction (MI) patients, suggesting it may be more crucial for improving outcomes in MI.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Massive intracerebral hemorrhage (ICH) and major infarction (MI) are severe cerebrovascular events.
- Decompression craniectomy (DC) is a surgical intervention used for these conditions.
- Observed differences in postoperative intracranial pressure (ICP) trends between ICH and MI patients warrant further investigation.
Purpose of the Study:
- To compare ICP trends following DC in patients with ICH versus MI.
- To evaluate the clinical significance of these ICP trends and their impact on patient outcomes.
Main Methods:
- Retrospective analysis of 143 patients (81 ICH, 62 MI) who underwent DC.
- Consistent DC criteria: Glasgow Coma Scale (GCS) < 8 and midline shift > 6 mm.
- Pre-DC ventricular puncture and post-operative ICP monitoring.
Main Results:
- Postoperative ICP decreased rapidly and remained physiological in ICH patients with >80% hematoma removal (13.6 mmHg).
- MI patients exhibited sustained elevated ICP post-DC (18.8 mmHg) compared to ICH patients (p=0.000).
- Shorter operation times for ICH (7.3 hrs vs. 40.9 hrs for MI, p=0.000) and higher mortality for MI (37.1% vs. 17.3% for ICH, p=0.007).
Conclusions:
- DC is effective in managing ICP for ICH patients when significant hematoma removal is achieved.
- Sustained elevated ICP in MI patients suggests DC may be essential for improving outcomes.
- Timely treatment decisions regarding DC are crucial, particularly for MI patients.
Objective:
Massive intracerebral hemorrhage (ICH) and major infarction (MI) are devastating cerebral vascular diseases. Decompression craniectomy (DC) is a common treatment approach for these diseases and acceptable clinical results have been reported. Author experienced the postoperative intracranaial pressure (ICP) trend is somewhat different between the ICH and MI patients. In this study, we compare the ICP trend following DC and evaluate the clinical significance.
Methods:
One hundred forty-three patients who underwent DC following massive ICH (81 cases) or MI (62 cases) were analyzed retrospectively. The mean age was 56.3±14.3 (median=57, male : female=89 : 54). DC was applied using consistent criteria in both diseases patients; Glasgow coma scale (GCS) score less than 8 and a midline shift more than 6 mm on brain computed tomography. In all patients, ventricular puncture was done before the DC and ICP trends were monitored during and after the surgery. Outcome comparisons included the ictus to operation time (OP-time), postoperative ICP trend, favorable outcomes and mortality.
Results:
Initial GCS (p=0.364) and initial ventricular ICP (p=0.783) were similar among the ICH and MI patients. The postoperative ICP of ICH patients were drop rapidly and maintained within physiological range if greater than 80% of the hematoma was removed. While in MI patients, the postoperative ICP were not drop rapidly and maintained above the physiologic range (MI=18.8 vs. ICH=13.6 mmHg, p=0.000). The OP-times were faster in ICH patients (ICH=7.3 vs. MI=40.9 hours, p=0.000) and the mortality rate was higher in MI patients (MI=37.1% vs. ICH=17.3%, p=0.007).
Conclusion:
The results of this study suggest that if greater than 80% of the hematoma was removed in ICH patients, the postoperative ICP rarely over the physiologic range. But in MI patients, the postoperative ICP was above the physiologic range for several days after the DC. Authors propose that DC is no need for the massive ICH patient if a significant portion of their hematoma is removed. But DC might be essential to improve the MI patients' outcome and timely treatment decision.
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