Zaporožskij Medicinskij Žurnal (Oct 2019)
The influence of decompressive craniectomy on intracranial pressure in patients with severe traumatic brain injury
Abstract
A prospective study of decompressive craniectomy (DC) influence on intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) has been performed using intraoperative and postoperative monitoring. Purpose. To study quantitative indicators of DC influence on ICP in patients with severe TBI through continuous intraoperative and postoperative monitoring. Materials and methods. A total of 75 patients (14 women and 61 men) with severe TBI (the GCS score at admission was 8 or less) who underwent DC and dura mater opening with further duraplasty were included in the study. A unilateral wide fronto-temporo-parietal decompression was performed. Primary DC was performed in 64 patients. Secondary DC was performed in 11 patients. ICP measurements were carried out using parenchymal sensors on the REF HDM 26.1/FV500 Brain Pressure Monitor (Spiegelberg,Hamburg,Germany). ICP sensor was installed during the first surgery stage. In each case, a decompressive effect of each surgery stage and the entire surgery was assessed. Results. High ICP was diagnosed in 86.7 % of patients preoperatively and in 24 % of patients (P < 0.05) postoperatively. The mean post-DC ICP decreased from 39 mmHg (preoperative) to 15.8 mmHg (postoperative), the average decrease was 59.5 % from the baseline. The largest decrease in ICP by 42.6 % was detected after bone flap removal. Dura mater opening resulted to additional decrease in ICP by 24.7 %. Conclusions. A unilateral wide fronto-temporo-parietal craniectomy is an effective method for sustainable ICP reduction. DC reduces the percentage of patients with intracranial hypertension. Decompressive effect of a surgery does not significantly depend on DC, brain injury type or traumatic compression substrate.
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