Multimodality neuromonitoring and decompressive hemicraniectomy after subarachnoid hemorrhage.
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.
Stuart
Robert Morgan
RM
Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. rms2130@columbia.edu
Claassen
Jan
J
Schmidt
Michael
M
Helbok
Raimund
R
Kurtz
Pedro
P
Fernandez
Luis
L
Lee
Kiwon
K
Badjatia
Neeraj
N
Mayer
Stephan A
SA
Lavine
Sean
S
Connolly
E Sander
ES
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*