Determining the Lower Limit of Cerebral Perfusion Pressure in Patients Undergoing Decompressive Craniectomy Following Traumatic Brain Injury

Eun, Jin; Huh, Jae Won; Yang, Suk‐Woo; Huh, Han-Yong; Ahn, Jaekun; Cho, Kwang-Wook; Kim, Young Woo; Kim, Sung-Lim; Kim, Jong-Tae; Yoo, Do Sung; Park, Hae Kwan; Ji, Cheol

doi:10.1016/j.wneu.2017.11.146

Cited by 3 publications

(3 citation statements)

References 29 publications

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“…DC is an advanced treatment option for ICP control that allows the CPP and CBF to be maintained at levels that prevent ischemic injury. Also, the edematous brain herniates through the craniectomy opening rather than the tentorial incisura, thus avoiding brainstem compression [ 8 , 11 , 17 , 31 , 37 , 43 , 47 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…Decompressive craniectomy (DC) has been proposed as a therapeutic option for ICP unresponsive to conventional treatment modalities. DC preserves the cerebral blood flow (CBF) hemodynamics and prevents transtentorial herniation and secondary damage [ 11 , 17 , 37 , 40 , 47 ]. Many studies have reported that early DC improves survival rates and clinical outcomes compared to medical treatment alone.…”

Section: Introductionmentioning

confidence: 99%

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Proper Indication of Decompressive Craniectomy for the Patients with Massive Brain Edema after Intra-arterial Thrombectomy

Im,

Yoo,

Park

2024

J Korean Neurosurg Soc

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Objective : Numerous studies have indicated that early decompressive craniectomy (DC) for patients with major infarction can be life-saving and enhance neurological outcomes. However, most of these studies were conducted by neurologists before the advent of intra-arterial thrombectomy (IA-Tx). This study aims to determine whether neurological status significantly impacts the final clinical outcome of patients who underwent DC following IA-Tx in major infarction.Methods : This analysis included 67 patients with major anterior circulation major infarction who underwent DC after IA-Tx, with or without intravenous tissue plasminogen activator. We retrospectively reviewed the medical records, radiological findings, and compared the neurological outcomes based on the “surgical time window” and neurological status at the time of surgery.Results : For patients treated with DC following IA-Tx, a Glasgow coma scale (GCS) score of 7 was the lowest score correlated with a favorable outcome (p=0.013). Favorable outcomes were significantly associated with successful recanalization after IA-Tx (p=0.001) and perfusion/diffusion (P/D)-mismatch evident on magnetic resonance imaging performed immediately prior to IA-Tx (p=0.007). However, the surgical time window (within 36 hours, p=0.389; within 48 hours, p=0.283) did not correlate with neurological outcomes.Conclusion : To date, early DC surgery after major infarction is crucial for patient outcomes. However, this study suggests that the indication for DC following IA-Tx should include neurological status (GCS ≤7), as some patients treated with early DC without considering the neurological status may undergo unnecessary surgery. Recanalization of the occluded vessel and P/D-mismatch are important for long-term neurological outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proper Indication of Decompressive Craniectomy for the Patients with Massive Brain Edema after Intra-arterial Thrombectomy

Im,

Yoo,

Park

2024

J Korean Neurosurg Soc

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“…We also lack the knowledge to determine appropriate neurocritical care parameters specifically for female military personnel, as the currently accepted ICP and cerebral perfusion pressure targets for TBI patients are based on male-predominant data. 21 Evidence on female-specific parameters is sparse and inconclusive. A 2011 study conducted in 459 patients admitted for TBI proposes a lower ICP threshold of 18 mm Hg for favorable outcome, suggesting that women with TBI may be less tolerant of intracranial hypertension.…”

Section: Medical Management Of Tbimentioning

confidence: 99%

Traumatic brain injury among female veterans: a review of sex differences in military neurosurgery

Kim

Quon

Sun

et al. 2018

Neurosurgical Focus

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The impact of traumatic brain injury (TBI) has been demonstrated in various studies with respect to prevalence, morbidity, and mortality data. Many of the patients burdened with long-term sequelae of TBI are veterans. Although fewer in number, female veterans with TBI have been suggested to suffer from unique physical, mental, and social challenges. However, there remains a significant knowledge gap in the sex differences in TBI. Increased female representation in the military heralds an increased risk of TBI for female soldiers, and medical professionals must be prepared to address the unique health challenges in the face of changing demographics among the veteran TBI population. In this review, the authors aimed to present the current understanding of sex differences in TBI in the veteran population and suggest directions for future investigations.

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Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion

Pranevicius

Pranevičius

Pranevicius

2021

Sci Rep

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Cerebral perfusion is determined by segmental perfusion pressure for the intracranial compartment (SPP), which is lower than cerebral perfusion pressure (CPP) because of extracranial stenosis. We used the Thevenin model of Starling resistors to represent the intra-extra-cranial compartments, with outflow pressures ICP and Pe, to express SPP = Pd–ICP = FFR*CPP–Ge(1 − FFR)(ICP–Pe). Here Pd is intracranial inflow pressure in the circle of Willis, ICP—intracranial pressure; FFR = Pd/Pa is fractional flow reserve (Pd scaled to the systemic pressure Pa), Ge—relative extracranial conductance. The second term (cerebral venous steal) decreases SPP when FFR < 1 and ICP > Pe. We verified the SPP equation in a bench of fluid flow through the collapsible tubes. We estimated Pd, measuring pressure in the intra-extracranial collateral (supraorbital artery) in a volunteer. To manipulate extracranial outflow pressure Pe, we inflated the infraorbital cuff, which led to the Pd increase and directional Doppler flow signal reversal in the supraorbital artery. SPP equation accounts for the hemodynamic effect of inflow stenosis and intra-extracranial flow diversion, and is a more precise perfusion pressure target than CPP for the intracranial compartment. Manipulation of intra-extracranial pressure gradient ICP–Pe can augment intracranial inflow pressure (Pd) and reverse intra-extracranial steal.

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Determining the Lower Limit of Cerebral Perfusion Pressure in Patients Undergoing Decompressive Craniectomy Following Traumatic Brain Injury

Cited by 3 publications

References 29 publications

Proper Indication of Decompressive Craniectomy for the Patients with Massive Brain Edema after Intra-arterial Thrombectomy

Proper Indication of Decompressive Craniectomy for the Patients with Massive Brain Edema after Intra-arterial Thrombectomy

Traumatic brain injury among female veterans: a review of sex differences in military neurosurgery

Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion

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