Abstract:
OBJECT:The management of massive brain swelling remains an unsolved problem in neurosurgery. Despite newly developed medical and pharmacological therapy, the rates of mortality and morbidity caused by massive brain swelling remain high. According to many recent reports, surgical decompression with dural expansion is superior to medical management in patients with massive brain swelling. To show the quantitative effect of decompressive surgery on intracranial pressure (ICP), the authors performed a ventricular puncture and measured the ventricular ICP continuously during decompressive surgery and the postoperative period. METHODS:Twenty patients with massive brain swelling who underwent bilateral decompressive craniectomy with dural expansion were included in this study. In all patients, ventricular puncture was performed at Kocher's point on the side opposite the massive brain swelling. The ventricular puncture tube was connected to the continuous monitor via a transducer device. The ventricular pressure was monitored continuously, during the bilateral decompressive procedures and postoperative period. The initial ventricular ICP was variable, ranging from 16 to 65.8 mm Hg. Immediately after the bilateral craniectomy, the mean ventricular ICP decreased to 50.2+/-16.6% of the initial ICP (range 5-51.5 mm Hg). Additional opening of the dura decreased the mean ICP by an additional 34.5% and reduced the ventricular pressure to 15.7+/-10.7% of the initial pressure (range 0-15 mm Hg). Ventricular pressure measured postoperatively in the neurosurgical intensive care unit was lowered to 15.1+/-16.5% of the initial ICP. The ventricular ICP trend in the first 24 hours after decompressive surgery was an important prognostic factor; if it was greater than 35 mm Hg, the mortality rate was 100%. CONCLUSIONS:Bilateral decompression with dural expansion is an effective therapeutic modality in the control of ICP. To obtain favorable clinical outcomes in patients with massive brain swelling, early decision making and proper patient selection are very important.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Yoo DS,Kim DS,Cho KS,Huh PW,Park CK,Kang JKdoi
10.3171/jns.1999.91.6.0953subject
Has Abstractpub_date
1999-12-01 00:00:00pages
953-9issue
6eissn
0022-3085issn
1933-0693journal_volume
91pub_type
杂志文章abstract::The authors report the neuroimaging features, treatment planning, and outcome in a case of radiosurgical thalamotomy targeting the centromedian nucleus (CMN) for stroke-induced thalamic pain. A 79-year-old man, with embolic occlusion of the left middle cerebral artery and large hemispheric infarction involving the tha...
journal_title:Journal of neurosurgery
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doi:10.3171/jns.1984.60.5.0927
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pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.3171/2020.3.JNS20319
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doi:10.3171/jns.1999.91.4.0669
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.3171/jns.1978.49.6.0839
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pub_type: 杂志文章
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更新日期:2006-10-01 00:00:00
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pub_type: 评论,杂志文章
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更新日期:2017-05-01 00:00:00
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pub_type: 杂志文章,评审
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doi:10.3171/jns.2002.97.4.0827
更新日期:2002-10-01 00:00:00
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journal_title:Journal of neurosurgery
pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.3171/2019.12.JNS192940
更新日期:2020-02-28 00:00:00
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journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1994.81.6.0947
更新日期:1994-12-01 00:00:00
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pub_type: 杂志文章
doi:10.3171/jns.1984.61.1.0193
更新日期:1984-07-01 00:00:00
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pub_type: 杂志文章
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更新日期:2002-09-01 00:00:00
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pub_type: 杂志文章
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更新日期:2019-02-01 00:00:00
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更新日期:2008-06-01 00:00:00
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pub_type: 杂志文章
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更新日期:1991-02-01 00:00:00