Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurg. 2022 Jan;157:e351-e356. doi: 10.1016/j.wneu.2021.10.088. Epub 2021 Oct 14.
Primary decompressive craniectomy (DC) is commonly performed for patients with traumatic brain injury (TBI). Some, but not all patients, will benefit from invasive monitoring of intracranial pressure (ICP) after surgery. We intended to identify risk factors for elevated ICP after primary DC to treat TBI.
A retrospective chart review study identified all patients at our institution who underwent primary DC for TBI during the study period and who had ICP monitors placed at the time of surgery. Various preoperative and intraoperative variables were assessed for correlation with the presence of postoperative elevated ICP.
Postoperative elevated ICP occurred in 36% of patients after DC. In univariate analysis, Glasgow Coma Scale <8, abnormal pupillary examination, and intraoperative brain swelling were all associated with elevated postoperative ICP. However, in multivariate analysis only intraoperative brain swelling was associated with elevated postoperative ICP (incidence 56% vs. 5%, P = 0.0043).
Placement of an ICP monitor at the time of primary DC for patients with TBI should be considered if there is intraoperative brain swelling.
原发性去骨瓣减压术（DC）常用于治疗创伤性脑损伤（TBI）患者。一些患者（但不是所有患者）术后需要进行颅内压（ICP）有创监测以获益。我们旨在确定原发性 DC 治疗 TBI 后 ICP 升高的危险因素。
一项回顾性图表审查研究确定了研究期间在我院接受原发性 DC 治疗 TBI 的所有患者，这些患者在手术时都放置了 ICP 监测仪。评估了各种术前和术中变量与术后 ICP 升高的相关性。
DC 术后 36%的患者 ICP 升高。单因素分析中，格拉斯哥昏迷量表（GCS）评分<8、瞳孔检查异常和术中脑肿胀均与术后 ICP 升高相关。但多因素分析中仅术中脑肿胀与术后 ICP 升高相关（发生率分别为 56%和 5%，P=0.0043）。
如果术中存在脑肿胀，应考虑在原发性 DC 时为 TBI 患者放置 ICP 监测仪。
