title: Subdural pressure measurement during posterior fossa surgery. Correlation studies of brain swelling/herniation after dural incision with measurement of subdural pressure and tactile estimation of dural tension.
abstract: Thirty-two patients with posterior fossa tumours or arteriovenous malformations were subjected to elective craniotomy in the prone position. The intracranial pressure (ICP) was measured by a subdural approach in the open area of the exposed dura. Estimation of dural tension before dural incision and the degree of brain swelling/herniation after opening the dura were correlated with the subdural pressure measured with intact dura. The results indicate that at ICP < 10 mmHg, brain swelling/herniation rarely occurred, while at ICP > or = 10 mmHg some degree of brain swelling/herniation was always present. The neurosurgeon's tactile estimation of dural tension correlated poorly with any tendency to brain swelling/herniation. It is concluded that measurement of subdural pressure is a better predictor of the risk of brain swelling/herniation than the tactile estimation of dural tension during posterior fossa surgery.
authors.affiliation: Department of Neuroanaesthesia, Aarhus University Hospital, Denmark.
authors.forename: H A
authors.initials: HA
authors.lastname: Jørgensen
authors.forename: H
authors.initials: H
authors.lastname: Bundgaard
authors.forename: G E
authors.initials: GE
authors.lastname: Cold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000502:physiology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D004677:Encephalocele / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000503:physiopathology / Q000601:surgery*; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012888:Skull Neoplasms / Q000503:physiopathology / Q000601:surgery*