Invasive Monitoring of Intracranial Pressure After Decompressive Craniectomy in Malignant Stroke.

Abstract:

BACKGROUND AND PURPOSE:The role of decompressive hemicraniectomy (DC) in malignant cerebral infarction (MCI) has clearly been established, but little is known about the course of intracranial pressure (ICP) in patients undergoing this surgical measure. In this study, we investigated the role of invasive ICP monitoring in patients after DC for MCI, postulating that postoperative ICP predicts mortality. METHODS:In this retrospective observational study of MCI patients undergoing DC, ICP were recorded continuously in hourly intervals for the first 72 hours after DC. For every hour, mean ICP was calculated, pooling ICP of every patient. A receiver operating characteristic analysis was performed for hourly mean ICP. A subgroup analysis by age (≥60 years and <60 years) was also performed. RESULTS:A total of 111 patients were analyzed, with 29% mortality rate in patients <60 years, and 41% in patients ≥60 years. A threshold of 10 mm Hg within the first 72 postoperative hours was a reliable predictor of mortality in MCI, with an acceptable sensitivity of 70% and high specificity of 97%. Established predictors of mortality failed to predict mortality. CONCLUSIONS:Our study suggests the need to reevaluate postoperative ICP after DC in MCI and calls for a redefinition of ICP thresholds in these patients to indicate further therapy.

journal_name

Stroke

journal_title

Stroke

authors

Hernández-Durán S,Meinen L,Rohde V,von der Brelie C

doi

10.1161/STROKEAHA.120.032390

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

707-711

issue

2

eissn

0039-2499

issn

1524-4628

journal_volume

52

pub_type

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