title: Multimodality neuromonitoring and decompressive hemicraniectomy after subarachnoid hemorrhage.
abstract: METHODS
  We report the case of a young woman with delayed cerebral infarction and intracranial hypertension following subarachnoid hemorrhage requiring hemicraniectomy, who underwent multimodality neuromonitoring of the contralateral hemisphere before and after craniectomy.
  
  
  RESULTS
  Intracranial hypertension was preceded by signs of ischemia and impaired brain metabolism diagnosed through cerebral microdialysis and PbtO2 monitoring, as well as a decrease in cerebral perfusion pressure (CPP) to <40 mmHg despite increasing vasopressor requirements. We describe how a comprehensive multimodality neuromonitoring approach was utilized to inform the decision to perform an early decompressive hemicraniectomy. Post-operatively, CPP and intracranial pressure (ICP) normalized, and the patient was weaned off all pressors within hours. The modified Rankin score at 3 and 12 months was 5.
  
  
  CONCLUSIONS
  Delayed rescue hemicraniectomy can be life-saving after poor grade SAH. The role of multimodality brain monitoring for determining the optimal timing of hemicraniectomy deserves further study.
authors: Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. rms2130@columbia.edu
authors: Robert Morgan
authors: RM
authors: Stuart
authors: Jan
authors: J
authors: Claassen
authors: Michael
authors: M
authors: Schmidt
authors: Raimund
authors: R
authors: Helbok
authors: Pedro
authors: P
authors: Kurtz
authors: Luis
authors: L
authors: Fernandez
authors: Kiwon
authors: K
authors: Lee
authors: Neeraj
authors: N
authors: Badjatia
authors: Stephan A
authors: SA
authors: Mayer
authors: Sean
authors: S
authors: Lavine
authors: E Sander
authors: ES
authors: Connolly
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D056424:Decompressive Craniectomy; D003943:Diagnostic Techniques, Neurological; D005260:Female; D006801:Humans; D017551:Microdialysis; D016343:Monitoring, Intraoperative; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*