title: Cerebral edema leading to decompressive craniectomy: an assessment of the preceding clinical and neuromonitoring trends.
abstract: The aim of this study was to examine the pre-operative clinical and neuromonitoring courses in patients with a decompressive craniectomy to assess and to compare clinical and neuromonitoring signs indicating extensive cerebral edema. We conducted a retrospective analysis of the clinical signs and courses of simultaneous monitoring of intracranial pressure (ICP) and cerebral oxygenation (PtiO2) in 26 consecutive patients who were sedated and treated with a decompressive craniectomy due to extensive cerebral edema after aneurysmal subarachnoid hemorrhage (SAH) (n = 20) or severe head injury (SHI) (n = 6). Pathological monitoring trends always preceded clinical deterioration. In 18 of 26 patients extensive cerebral edema was indicated solely by increasing ICP > 20 mmHg or decreasing PtiO2 < 10 mmHg or both. Anisocoria occurred in only 8 of 26 patients. As opposed to SHI patients, 9 of 20 SAH patients showed decreasing PtiO2 as first warning sign clearly before neurological deterioration or ICP increase. This series shows the utility of combined ICP and PtiO2 monitoring in patients who develop extensive cerebral edema. Pathological monitoring trends indicate deterioration prior to clinical signs which offers a wider therapeutical window. PtiO2 monitoring appears to be particularly valuable after aneurysmal SAH as adjunct to ICP monitoring and CT imaging.
authors.affiliation: Department of Neurosurgery, Klinikum Plau am See, 19395 Plau am See, Germany. rainer_strege@gmx.de
authors.forename: Rainer J
authors.initials: RJ
authors.lastname: Strege
authors.forename: Erhard W
authors.initials: EW
authors.lastname: Lang
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Stark
authors.forename: Heike
authors.initials: H
authors.lastname: Scheffner
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fritsch
authors.forename: Harald
authors.initials: H
authors.lastname: Barth
authors.forename: H Maximilian
authors.initials: HM
authors.lastname: Mehdorn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000601:surgery; D003399:Craniotomy; D003422:Critical Care; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D011300:Preoperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D010100:Oxygen