Effect of increased ICP and decreased CPP on DND and outcome in ASAH.
BACKGROUND
When clipping is done early in aneurysmal SAH (ASAH), postoperative increased ICP and decreased CPP may present and influence development of delayed neurological deficit (DND), irreversible neurological deficit (IRND) and poor outcome.


METHODS
A retrospective study was performed in 30 early clipping ASAH with postoperative ICP monitoring, flow velocity measurement, triple H-nimodipine therapy, ICP-CPP orientated strategy and a 3-month follow-up period. Chi-squared test was performed on increased ICP, decreased CPP, combination of increased ICP+ decreased CPP and DND, IRND and poor outcome.


RESULTS
Two (7%), 19 (63%) and 9 (30%) patients were H&H 2, 3 and 4 respectively. Mean ICP and CPP were 34.2 and 71.3 mmHg. Mean ICP in H&H 2, 3 and 4 was 17.6, 34.3 and 50.2 mmHg respectively. 58.3%, 58.8% and 70% of patients with ICP ≥ 20, 30 and 40 mmHg had DND. 64.7%, 63.3% and 80% of patients with CPP ≤ 80, 70 and 60 mmHg had DND. 37.5%, 41.1% and 40% of patients with ICP ≥ 20, 30 and 40 mmHg had poor outcome. 41.1%, 27.2% and 40% of patients with CPP ≤ 80, 70 and 60 mmHg had poor outcome. Statistical analysis could not demonstrate a significant relationship among any of the parameters.


CONCLUSIONS
Postoperative increased ICP is frequent in early clipping especially in poor-grade ASAH; decreased CPP is less frequent, possibly owing to triple H therapy and ICP-CPP orientated strategy. Increased ICP seems to be more detrimental than decreased CPP. Increased ICP and decreased CPP may affect deterioration of neurological function in terms of DND, IRND and poor outcome as secondary insult.
Department of Neurosurgery, Rangsit University, Bangkok, Thailand. patarapol@hotmail.com
Krissanee
K
Karnchanapandh
D000328:Adult; D000368:Aged; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D016009:Chi-Square Distribution; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*