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DOI: 10.1590/0004-282X20180132
Intracranial pressure following decompressive hemicraniectomy for malignant cerebral infarction: clinical and treatment correlations
Monitorização da pressão intracraniana em pacientes tratados com hemicraniectomia descompressiva por acidente vascular cerebral maligno de artéria cerebral média: correlações clínicas e terapêuticas
ABSTRACT
Decompressive craniectomy (DC) reduces mortality and improves outcome in patients with massive brain infarctions. The role of intracranial pressure (ICP) monitoring following DC for stroke has not been well established.
Methods: We evaluated 14 patients admitted to a tertiary hospital with malignant middle cerebral artery infarctions, from October 2010 to February 2015, who underwent DC and had ICP monitoring. Patients with and without episodes of ICP elevation were compared.
Results: Fourteen patients were submitted to DC and had ICP monitoring following the procedure during the period. Ten patients (71.4%) had at least one episode of sustained elevated ICP in the first seven days after surgery. Maximal ICP levels had no correlation with age, time to hemicraniectomy or Glasgow Coma Scores at admission, but had a trend toward correlation with the National Institutes of Health Stroke Scale score at admission (p = 0.1). Ventriculitis occurred in 21.4% of the patients.
Conclusions: High ICP episodes and ventriculitis were common in patients following hemicraniectomy for malignant middle cerebral artery strokes. Therefore, the implications of ICP and benefits of the procedure should be firmly established.
RESUMO
Craniectomia descompressiva (CD) reduz a mortalidade e melhora o desfecho em pacientes com infartos malignos de artéria cerebral média (ACM). O papel da monitorização da pressão intracraniana (PIC) após CD para infartos malignos de ACM não está bem estabelecido.
Métodos: Avaliamos pacientes consecutivos internados em um hospital terciário com infartos malignos de ACM de outubro/2010 a fevereiro/2015 tratados com CD e submetidos à monitorização da PIC. Foram comparados pacientes com e sem episódios de elevação de PIC.
Resultados: Quatorze pacientes (idade média 49,0 ± 12,4 anos, 42,9% do sexo masculino) foram avaliados. Dez pacientes (71,4%) tiveram pelo menos um episódio de elevação da PIC nos primeiros sete dias após a cirurgia. A PIC máxima média foi de 26,71 ± 11,64 mmHg. Os níveis máximos de PIC não apresentaram correlação com a idade, o tempo de hemicraniectomia ou com a pontuação na Escala de Coma de Glasgow na admissão, mas houve tendência a ser correlacionada com a pontuação da National Institutes of Health Stroke Scale na admissão (p = 0,1). Ventriculite ocorreu em 21,4% dos pacientes.
Conclusões: Os episódios de aumento da PIC foram comuns em pacientes tratados com CD por infarto maligno de MCA e ventriculite foi evento adverso frequente nesses pacientes. Portanto, as implicações da monitorização da PIC sobre o resultado funcional, bem como os riscos e benefícios do procedimento, devem ser melhor estabelecidos.
Publication History
Received: 11 October 2017
Accepted: 27 August 2018
Article published online:
22 August 2023
© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015 Jan;131(4):e29-322. https://doi.org/10.1161/CIR.20180132201801320152
- 2 Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, Kummer R. 'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996 Apr;53(4):309-15. https://doi.org/10.1001/archneur.1996.00550040037012
- 3 Mohr JP, Wolf PA, Grotta JC,. Moskowitz MA, Mayberg M, Kummer RStroke: pathophysiology, diagnosis, and management. 5a ed. Philadelphia, PA: Saunders; 2011. Vol. 1.
- 4 Jüttler E, Schwab S, Schmiedek P Unterberg A, Hennerici M, Woitzik J. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke. 2007 Sep;38(9):2518-25. https://doi.org/10.1161/STROKEAHA.107.485649
- 5 Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007 Sep;38(9):2506-17. https://doi.org/10.1161/STROKEAHA.107.485235
- 6 Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, Worp HB. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009 Apr;8(4):326-33. https://doi.org/10.1016/S1474-4422(09)70047-X
- 7 Paldor I, Rosenthal G, Cohen JE, Leker R, Harnof S, Shoshan Y et al. Intracranial pressure monitoring following decompressive hemicraniectomy for malignant cerebral infarction. J Clin Neurosci. 2015 Jan;22(1):79-82. https://doi.org/10.1016/j.jocn.2014.07.006
- 8 Sauvigny T, Gottsche J, Czorlich P Vettorazzi E, Westphal M, Regelsberger J. Intracranial pressure in patients undergoing decompressive craniectomy: new perspective on thresholds. J Neurosurg. 2018 Mar;128(3):819-27. https://doi.org/10.3171/2016.11.JNS162263
- 9 Jeon SB, Park JC, Kwon SU, Kim YJ, Lee S, Kang DW et al. Intracranial Pressure Soon After Hemicraniectomy in Malignant Middle Cerebral Artery Infarction. J Intensive Care Med. 2018 May;33(5):310-6. https://doi.org/10.1177/0885066616675598