Bundgaard H, Landsfeldt U, Cold G E
Department of Neuroanaesthesia, Aarhus University Hospital, Denmark.
Acta Neurochir Suppl. 1998;71:276-8. doi: 10.1007/978-3-7091-6475-4_80.
It is possible to define thresholds for cerebral swelling or herniation during craniotomy. In 178 patients subjected to craniotomy for space occupying processes subdural ICP was measured before opening of dura. The subdural ICP was correlated to the degree of cerebral swelling or herniation after opening of dura. At subdural ICP < 7 mm Hg cerebral swelling/herniation after opening of dura rarely occurs, while at ICP > or = 10 mm Hg cerebral swelling/herniation occurs with high probability. These ICP thresholds are independent of the pathophysiology (SAH, cerebral tumor), the anaesthetic agent (isoflurane, propofol) and the PaCO2 level (< or = 4.0 kPa, > 4.0 kPa). Generally, a good correlation between the tactile estimation of dural tension and the tendency to cerebral swelling or herniation after opening of dura was found. However, in 8.5% the surgeons were unable to predict swelling/herniation.
在开颅手术期间，可以定义脑肿胀或脑疝的阈值。对178例因占位性病变接受开颅手术的患者，在打开硬脑膜前测量硬膜下颅内压（ICP）。硬膜下ICP与打开硬脑膜后脑肿胀或脑疝的程度相关。当硬膜下ICP＜7mmHg时，打开硬脑膜后脑肿胀/脑疝很少发生，而当ICP≥10mmHg时，脑肿胀/脑疝很可能发生。这些ICP阈值与病理生理学（蛛网膜下腔出血、脑肿瘤）、麻醉剂（异氟烷、丙泊酚）和动脉血二氧化碳分压水平（≤4.0kPa、＞4.0kPa）无关。一般来说，发现硬脑膜张力的触觉估计与打开硬脑膜后脑肿胀或脑疝的倾向之间有良好的相关性。然而，在8.5%的病例中，外科医生无法预测肿胀/脑疝。
