[Evaluation of the clinical benefit of decompression hemicraniectomy in intracranial hypertension not controlled by medical treatment].
Through the findings in the literature on the basis of 9 personal cases, we review the indications and value of decompressive hemicraniectomy with plasty of the dura mater in cases of medically uncontrolled and decompensated intracranial hypertension. Seven patients had a pseudo-tumoral brain infarction. Five patients survived and their functional recovery is consistent with an autonomous daily life. Another patient with acute traumatic sub-dural haemorrhage died. The ninth patient had presuppurative encephalitis and recovered with no disability. At the time of surgery, all the patients were comatose with herniation of the mesencephalon (n = 3), uncal transtentorial herniation which was either unilateral (n = 4) or bilateral (n = 2). ICP was between 25 and 60 mmHg before the operation. After flap removal, ICP decreased by 15% and, after opening of the dura, it fell a further 70%. In 6 patients we were able to carry out continued post-operative monitoring of ICP, which stayed below 50% of initial values. Decompressive hemicraniectomy is an effective means of treating ICH caused by carotid cerebrovascular accidents with a high degree of edema, where mortality rises to 70-85% when only medical treatment is administered. No haemorrhagic complications, which can occur during hemispherectomies, were observed during decompression.
Jourdan
C
C
Service d'Anesthésie Réanimation, Hôpital Neurologique Pierre-Wertheimer, Lyon.
Convert
J
J
Mottolese
C
C
Bachour
E
E
Gharbi
S
S
Artru
F
F
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000628:therapy; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D011559:Pseudotumor Cerebri / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Evaluation du bénéfice clinique de l'hémicraniectomie décompressive dans l'hypertension intracranienne non contrôlée par le traitement médical.