Lim Jia Xu, Liu Sherry Jiani, Cheong Tien Meng, Saffari Seyed Ehsan, Han Julian Xinguang, Chen Min Wei
National Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, Singapore.
Center for Qualitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
Front Surg. 2022 May 6;9:823899. doi: 10.3389/fsurg.2022.823899. eCollection 2022.
Decompressive craniectomy (DC) improves the survival and functional outcomes in patients with malignant cerebral infarction. Currently, there are no objective intraoperative markers that indicates adequate decompression. We hypothesise that closure intracranial pressure (ICP) correlates with postoperative outcomes.
This is a multicentre retrospective review of all 75 DCs performed for malignant cerebral infarction. The patients were divided into inadequate ICP (iICP) and good ICP (gICP) groups based on a suitable ICP threshold determined with tiered receiver operating characteristic and association analysis. Multivariable logistic regression was performed for various postoperative outcomes.
An ICP threshold of 7 mmHg was determined, with 36 patients (48.0%) and 39 patients (52.0%) in the iICP and gICP group, respectively. After adjustment, postoperative osmotherapy usage was more likely in the iICP group (OR 6.32, = 0.003), and when given, was given for a longer median duration (iICP, 4 days; gICP, 1 day, = 0.003). There was no difference in complications amongst both groups. When an ICP threshold of 11 mmHg was applied, there was significant difference in the duration on ventilator (ICP ≥11 mmHg, 3-9 days, ICP <11 mmHg, 3-5 days, = 0.023).
Surgical decompression works complementarily with postoperative medical therapy to manage progressive cerebral edema in malignant cerebral infarctions. This is a retrospective study which showed that closure ICP, a novel objective intraoperative biomarker, is able to guide the adequacy of DC in this condition. Various surgical manoeuvres can be performed to ensure that this surgical aim is accomplished.
减压性颅骨切除术（DC）可改善恶性脑梗死患者的生存率和功能结局。目前，尚无客观的术中指标可表明减压充分。我们假设闭合性颅内压（ICP）与术后结局相关。
这是一项对所有75例因恶性脑梗死而进行的DC手术的多中心回顾性研究。根据通过分层受试者工作特征和关联分析确定的合适ICP阈值，将患者分为ICP不充分（iICP）组和ICP良好（gICP）组。对各种术后结局进行多变量逻辑回归分析。
确定ICP阈值为7 mmHg，iICP组和gICP组分别有36例（48.0%）和39例（52.0%）。调整后，iICP组术后更可能使用渗透性疗法（OR 6.32，P = 0.003），且使用时，中位持续时间更长（iICP组为4天；gICP组为1天，P = 0.003）。两组并发症无差异。当应用11 mmHg的ICP阈值时，呼吸机使用时间有显著差异（ICP≥11 mmHg，3 - 9天；ICP < 11 mmHg，3 - 5天，P = 0.023）。
手术减压与术后药物治疗相辅相成，以处理恶性脑梗死中进行性脑水肿。这是一项回顾性研究，表明闭合性ICP作为一种新的客观术中生物标志物，能够在此种情况下指导DC的充分性。可采取各种手术操作以确保实现这一手术目标。
