Funchal Bruno Ferreira, Alves Maramélia Miranda, Suriano Ítalo C, Chaddad-Neto Feres Eduardo, Ferraz Maria E M R, Silva Gisele Sampaio
Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil.
Hospital Israelita Albert Einstein, Programa Integrado de Neurologia and Instituto de Ensino e Pesquisa, São Paulo SP, Brasil.
Arq Neuropsiquiatr. 2018 Dec;76(12):812-815. doi: 10.1590/0004-282X20180132.
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. 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.
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.
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.
减压性颅骨切除术（DC）可降低大面积脑梗死患者的死亡率并改善其预后。DC术后进行颅内压（ICP）监测在卒中治疗中的作用尚未明确。我们评估了2010年10月至2015年2月期间在一家三级医院收治的14例恶性大脑中动脉梗死患者，这些患者接受了DC并进行了ICP监测。对有和没有ICP升高发作的患者进行了比较。
在此期间，14例患者接受了DC手术并在术后进行了ICP监测。10例患者（71.4%）在术后前7天至少有一次持续性ICP升高发作。最高ICP水平与年龄、去骨瓣减压时间或入院时的格拉斯哥昏迷评分无关，但与入院时的美国国立卫生研究院卒中量表评分有相关趋势（p = 0.1）。21.4%的患者发生了脑室炎。
对于恶性大脑中动脉卒中患者，去骨瓣减压术后ICP升高发作和脑室炎很常见。因此，应明确ICP的影响以及该手术的益处。
