Surgical Treatment of Elevated Intracranial Pressure

Ahmadieh, Tarek Y. El; Adel, Joseph G.; Tecle, Najib E. El; Daou, Marc; Aoun, Salah G.; Nanney, Allan D.; Bendok, Bernard R.

doi:10.1016/j.nec.2013.03.003

Cited by 14 publications

(4 citation statements)

References 111 publications

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“…The mortality rate has also been shown to be further increased in patients with prolonged refractory elevated ICP. 4 5 6…”

Section: Introductionmentioning

confidence: 99%

“…The mortality rate has also been shown to be further increased in patients with prolonged refractory elevated ICP. 4,5,6 Extensive experimental and clinical data indicate that DC is a valuable treatment for reducing early lethality in malignant IH. This type of surgery has been performed in patients with extensive ischemic stroke, in whom, due to the development of cerebral edema, increased ICP, and consequent cerebral herniation, there is a high mortality rate.…”

Section: Introductionmentioning

confidence: 99%

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Decompressive Craniectomy in Extensive Ischemic Stroke. An Experience in a Single Institution

Echenique-Fajardo,

Izaguirre-González,

De Gouveia Rodríguez

et al. 2023

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Background Decompressive craniectomy (DC) is a valuable treatment for reducing early lethality in malignant intracranial hypertension (IH); however, it has been shown that the decision to implement DC in patients with extensive ischemic stroke should not be based solely on the detection of IH with the use of intracranial pressure (ICP) devices. Objective To establish the usefulness of DC in patients with extensive ischemic stroke who came to the emergency room during the period between May 2018 and March 2019. Methods This was an analytical, prospective, and longitudinal study whose population corresponded to all patients with a diagnosis of extensive ischemic stroke. Results The sample consisted of 5 patients, of which 3 were female and 2 males, the average age was 62.2 years old (minimum 49 years old, maximum 77 years old). Of all the patients who underwent DC, it was found that 80% of the patients did not present an increase in intracranial pressure. Decompressive craniectomy was not performed in a case that responded adequately to medical treatment. The mean values of ICP were 25 mmHg with a minimum value of 20 mmHg and a maximum value of 25 mmHg; in patients with a moderate value, the ICP averages were < 20 mmHg. The mortality was of 40% (RANKIN of 6 points). Conclusions Decompressive craniectomy is useful in extensive ischemic stroke. The decision to implement DC in patients with extensive stroke rests on clinicoradiological parameters. The monitoring of the IPC was not particularly useful in the early detection of the neurological deterioration of the patients studied.

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“…The mortality rate has also been shown to be further increased in patients with prolonged refractory elevated ICP. 4 5 6…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Decompressive Craniectomy in Extensive Ischemic Stroke. An Experience in a Single Institution

Echenique-Fajardo,

Izaguirre-González,

De Gouveia Rodríguez

et al. 2023

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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“…The procedure improves cerebral hemodynamics and brain oxygenation in patients with high ICP, which could decrease mortality and disability in some cases (1). Several intracranial conditions can generate high ICP, and timely treatment of these emergencies is essential to ameliorate intracranial hypertension that generates hypoxia, ischemia and cerebral herniation (2, 3). In low- and middle-income countries (LMICs) neurosurgical emergency care is sometimes delayed due to the lack of neurosurgical work-force or the absence of formal prehospital systems (4–6).…”

Section: Introductionmentioning

confidence: 99%

The Role of Decompressive Craniectomy in Limited Resource Environments

et al. 2019

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Decompressive craniectomy (DC) is a neurosurgical procedure useful to prevent and manage the impact of high intracranial pressure (ICP) that leads to brain herniation and brain's tissue ischemia. In well-resourced environment this procedure has been proposed as a last tier therapy when ICP is not controlled by medical therapies in the management of different neurosurgical emergencies like traumatic brain injury (TBI), stroke, infectious diseases, hydrocephalus, tumors, etc. The purpose of this narrative review is to discuss the role of DC in areas of low neurosurgical and neurocritical care resources. We performed a literature review with a specific search strategy in web repositories and some local and regional journals from Low and Middle-Income Countries (LMICs). The most common publications include case reports, case series and observational studies describing the benefits of the procedure on different pathologies but with several types of biases due to the absence of robust studies or clinical registries analysis in these kinds of environments.

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“…Intracranial hypertension is a common complication in many neurological diseases. Causes of intracranial hypertension include intracranial factors such as cerebral ischemia/hemorrhage, trauma, brain tumor, cerebral edema, and hydrocephalus, while extracranial factors include hypoxia, hypercarbia, hyperpyrexia, seizures, and drugs or their metabolites [ 1 ]. A series of measures are needed to control raised intracranial pressure (ICP) above 20 to 25 mmHg.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Continuous Micro-Pump Infusion of 3% Hypertonic Saline combined with Furosemide to Control Elevated Intracranial Pressure

et al. 2015

Med Sci Monit

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BackgroundElevated intracranial pressure is one of the most common problems in patients with diverse intracranial disorders, leading to increased morbidity and mortality. Effective management for increased intracranial pressure is based mainly on surgical and medical techniques with hyperosmolar therapy as one of the core medical treatments. The study aimed to explore the effects of continuous micro-pump infusions of 3% hypertonic saline combined with furosemide on intracranial pressure control.Material/MethodsWe analyzed data on 56 eligible participants with intracranial pressure >20 mmHg from March 2013 to July 2014. The target was to increase and maintain plasma sodium to a level between 145 and 155 mmol/L and osmolarity to a level of 310 to 320 mOsmol/kg.ResultsPlasma sodium levels significantly increased from 138±5 mmol/L at admission to 151±3 mmol/L at 24 h (P<0.01). Osmolarity increased from 282±11 mOsmol/kg at baseline to 311±8 mOsmol/kg at 24 h (P<0.01). Intracranial pressure significantly decreased from 32±7 mmHg to 15±6 mmHg at 24 h (P<0.01). There was a significant improvement in CPP (P<0.01). Moreover, central venous pressure, mean arterial pressure, and Glasgow Coma Scale slightly increased. However, these changes were not statistically significant.ConclusionsContinuous infusion of 3% hypertonic saline + furosemide is effective and safe for intracranial pressure control.

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Surgical Treatment of Elevated Intracranial Pressure

Cited by 14 publications

References 111 publications

Decompressive Craniectomy in Extensive Ischemic Stroke. An Experience in a Single Institution

Decompressive Craniectomy in Extensive Ischemic Stroke. An Experience in a Single Institution

The Role of Decompressive Craniectomy in Limited Resource Environments

Efficacy and Safety of Continuous Micro-Pump Infusion of 3% Hypertonic Saline combined with Furosemide to Control Elevated Intracranial Pressure

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