Ventricular pressure monitoring during bilateral decompression with dural expansion

Yoo, Do Sung; Kim, Dal-Soo; Cho, Kyung-Suck; Huh, Pil Woo; Park, Chun-Kun; Kang, Joon-Ki

doi:10.3171/jns.1999.91.6.0953

Cited by 113 publications

(92 citation statements)

References 64 publications

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“…It has been reported that the indications for DS in patients with SHI are the appearance of diffuse unilateral or bilateral brain swelling with correlating clinical deterioration; worsening of GCS score and/or dilation of pupils unresponsive to light; therapy-resistant increase in ICP to >30 mmHg and/or a reduction in CPP to <45 mmHg; and initial GCS score of ≥4 and a GCS score of at least 4 on the 1st posttraumatic day. [6,7,[9][10][11] Guerra et al [6] and Yoo et al [11] reported that patients with primary fatal brainstem lesions, that is, an initial and persisting GCS score of 3 and/or bilaterally fixed and dilated pupils, did not undergo DS. Additionally, other authors reported that exclusion criteria for DS are patients over 40 years of age with hypertonic extensor posturing (GCS motor score of 2); bilateral unreactive pupil ≥4 mm in diameter; bilateral intracranial lesions, and life-threatening concomitant medical disease.…”

Section: Discussion Causes Of Pupillary Dilation In Patients Withmentioning

confidence: 99%

“…[6] When the patient demonstrates compression signs of the upper brainstem in the early period of uncal or central transtentorial herniation due to uncontrollable ICP, despite the modern management protocols (intubation, artificial ventilation, ventricular drainage of cerebrospinal fluid (CSF), and osmotherapy with mannitol), DC has been recommended as a last treatment option. [7][8][9][10][11] However, the criteria for the use of DC in such patients with severe traumatic brain injury (STBI) have not been standardized. There are not many reports in the current literature about the necessity of decompressive surgery (DS) in patients with BNDP due to STBI or cerebrovascular accidents (CVA).…”

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confidence: 99%

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Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

Göksu

Uçar²,

Akyuz³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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AMAÇAğır travmatik beyin yaralanmalı (ATBY) ve bilateral reaktif olmayan pupil dilatasyonu (BRPD) olup, dekompresif cerrahi (DC) uygulanmış hastalarda Glasgow koma skalası (GKS), kafa içi basınç (KİB), serebral perfüzyon basın-cı (SPP) değişiklikleri ve uzun dönem klinik sonuçları değerlendirildi. GEREÇ VE YÖNTEMÇalışma gurubu, bölümümüzde ATBY nedeniyle DC uygulanan 147 hasta içerisinden BRPD'li 28 hastayı (11 kadın, 17 erkek) içerdi. BULGULAROrtalama GKS skoru, başvuruda 4,96±1,20, ameliyat ön-cesi dönemde 4 idi. Ölen hastalarda, DC sonrası ortalama KİB değerleri hayatta kalanlara göre anlamlı ölçüde yük-sekti (p<0,05). Ayrıca, DC sonrası KİB azalması, yaşayan hastalarda yine anlamlı olarak yüksekti (p<0,05). Tümden mortalite oranı %61,02 bulundu. Başvuruda ikinin üzeri GKS motor skoru anlamlı olarak düşük mortalite ile ilişki-li idi (p<0,05). Yaşayan 4 hasta taburcu sonrası birinci yıl-da (%14,28) işlevsel sonuç skoru (Glasgow sonuç skoru 4 ve 5) gösterdi. SONUÇATBY sonrası BRPD'li hastalarda sonuçlar her zaman ölümcül ya da olumsuz olmayabilir. Hızlı DC, özellikle başvuru GKS skoru 6, 7 olan hastalarda işlevsel sağkalım şansını artırabilir.Anahtar Sözcükler: Dekompresif cerrahi; travmatik beyin yaralanması; reaktif olmayan dilate pupil. BACKGROUNDWe investigated Glasgow Coma Scale (GCS) scores, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) changes, and long-term clinical outcomes in patients with severe traumatic brain injury (STBI) associated with bilateral non-reactive dilated pupils (BNDP) who underwent decompressive surgery (DS). METHODSThe study group consisted of 28 patients (11 females, 17 males) with BNDP from among 147 patients who underwent DS due to STBI in our department. RESULTSThe mean GCS score was 4.96±1.20 at admission and 4 preoperatively. Mean ICP in non-surviving patients after DS was higher (p<0.05). ICP decrease after DS was also higher in surviving patients than in non-surviving patients (p<0.05). The overall mortality rate was 61.02%. A GCS motor score >2 at admission was associated with lower mortality (p<0.05). Four of the surviving patients (14.28%) had a functional outcome (Glasgow Outcome Score: 4 and 5) at one year after hospital discharge. CONCLUSIONOutcome in patients with BNDP after STBI may not always be fatal or poor. Rapid DS may increase the chance of functional survival, especially in patients with admission GCS score of 6 or 7.

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Section: Discussion Causes Of Pupillary Dilation In Patients Withmentioning

confidence: 99%

mentioning

confidence: 99%

Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

Göksu

Uçar²,

Akyuz³

et al. 2012

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…1,2,4-7,9,11, [14][15][16]18,19,21,22,25,[27][28][29][31][32][33][34][35][36][37][38][39][40] The mean years of patient accrual were between 1987 and 2005. Total numbers in each GOS category are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Quality of life after hemicraniectomy for traumatic brain injury in adults

Danish

Barone

Lega

et al. 2009

FOC

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Decompressive hemicraniectomy is well accepted for the surgical treatment of intractable intracranial hypertension in cases in which medical management fails. Although it is performed as a life-saving procedure when death is imminent from intracranial hypertension, little is known about the functional outcomes for these patients on long-term follow-up. In this study, the authors performed a systematic review of the literature to examine neurological outcome after hemicraniectomy. A literature search revealed 29 studies that reported outcomes using GOS scores. The GOS scores were transformed to utility values for quality of life using a conversion method based on decision analysis modeling. Based on the literature, 1422 cases were analyzed. The average 6-month-postoperative mortality rate was 28.2%. The mean QOL value among survivors was 0.592, which corresponds roughly to a GOS score of 4. Although more studies are needed for validation of long-term neurological outcome after hemicraniectomy, the assumption that most patients remain in a vegetative state after this intervention is clearly incorrect.

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“…ICP values decrease by 15% once the bone fl ap is removed and by 70% once the dura is opened [8]. The bone fl ap which is removed at the time of surgery can be safely placed in a subcutaneous pouch in the anterior abdominal wall [9]. The outcome following decompressive craniectomy is especially heartening in younger individuals and in children [10].…”

Section: Our Techniquementioning

confidence: 99%

Decompressive craniectomy: an effective but underutilized option for intracranial pressure management

Mathai

Sahoo²

2008

Indian J Surg

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Introduction Decompressive Craniectomy is an effective option in the management of intractable intracranial hypertension. Aim and objectives Neuronal conservation can be achieved by aggressive decompression (hemicraniectomy).Material and methods In this series 12 patients with a Glasgow Coma Scale score of 8 or <8 with increased intracranial pressure underwent decompressive hemicraniectomy.Results The outcomes were prospectively evaluated. Eight patients were victims of traumatic brain injury. There were two patients who had suffered malignant Middle Cerebral Artery Infarctions, one patient had a cerebral venous thrombosis and one, an intracerebral hematoma. Four patients in this cohort died, while fi ve had good outcomes. ConclusionThe rationale and role of this relatively easy but underutilised procedure are discussed.

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Ventricular pressure monitoring during bilateral decompression with dural expansion

Abstract: Bilateral decompression with dural expansion is an effective therapeutic modality in the control of ICP. To obtain favorable clinical outcomes in patients with massive brain swelling, early decision making and proper patient selection are very important.

Cited by 113 publications

References 64 publications

Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

Quality of life after hemicraniectomy for traumatic brain injury in adults

Decompressive craniectomy: an effective but underutilized option for intracranial pressure management

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