title: Intracranial pressure monitoring following decompressive hemicraniectomy for malignant cerebral infarction.
abstract: Randomized controlled trials have demonstrated the efficacy of decompressive craniectomy in substantially decreasing mortality and improving functional outcome in middle cerebral artery infarction. The role of intracranial pressure (ICP) monitoring following decompressive craniectomy for stroke has not been well studied. We present a retrospective review of our experience with postoperative ICP monitoring in 12 stroke patients who underwent decompressive craniectomy. All elevations of ICP above a 20 mm Hg threshold were noted. ICP was recorded for 1417 hours during which 68 ICP elevations were seen. Nine out of 12 patients had events of raised ICP, including eight with more than three elevations. A total of 81 interventions were employed to treat elevated ICP; 71 were effective in reducing ICP below the 20 mm Hg threshold. The most frequent intervention was cerebrospinal fluid drainage via an external ventricular drain, which was effective in 85.4% of cases. Eleven out of 12 patients survived (92%) and attained a median modified Rankin Scale score of 4 (interquartile range 4-5) at a mean 15 month follow-up. In our experience, elevated ICP may commonly occur following decompressive craniectomy for stroke. Monitoring ICP influenced postoperative management and standard measures for reducing ICP were usually effective in the current series.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
authors.forename: Iddo
authors.initials: I
authors.lastname: Paldor
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel; Department of Neurosurgery, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Guy
authors.initials: G
authors.lastname: Rosenthal
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
authors.affiliation: Department of Neurology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Leker
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel Aviv, Israel.
authors.forename: Sagi
authors.initials: S
authors.lastname: Harnof
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Shoshan
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel. Electronic address: eyal.itshayek@gmail.com.
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D056424:Decompressive Craniectomy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery*; D019586:Intracranial Hypertension / Q000175:diagnosis*; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cerebral infarction; Decompressive surgery; Intracranial pressure; Middle cerebral artery; Stroke