Monitoring and intraoperative management of elevated intracranial pressure and decompressive craniectomy.
There are numerous clinical scenarios wherein a critically ill patient may present with neurologic dysfunction. In a general sense these scenarios often involve ischemia, trauma, or neuroexcitation. Each of these may include a period of decreased cerebral perfusion pressure, usually due to elevated intracranial pressure (ICP), eventually compromising cerebral blood flow sufficiently to produce permanent neuronal loss, infarction, and possibly brain death. Elevated ICP is thus a common pathway for neural demise and it may arise from a variety of causes, many of which may result in a neurosurgical procedure intended to ameliorate the impact or etiology of elevated ICP.
Kofke
W Andrew
WA
Department of Anesthesia and Critical Care, University of Pennsylvania, 3400 Spruce St., Dulles 7, Philadelphia, PA 19104, USA. andrew.kofke@uphs.upenn.edu
Stiefel
Michael
M
D000768:Anesthesia, General; D001927:Brain Diseases / Q000503:physiopathology* / Q000601:surgery; D003399:Craniotomy; D019299:Decompression, Surgical; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000628:therapy; D016343:Monitoring, Intraoperative