Intracranial pressure before and after cranioplasty: insights into intracranial physiology
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Intracranial pressure before and after cranioplasty : insights into intracranial physiology. / Lilja-Cyron, Alexander; Andresen, Morten; Kelsen, Jesper; Andreasen, Trine Hjorslev; Petersen, Lonnie Grove; Fugleholm, Kåre; Juhler, Marianne.
I: Journal of Neurosurgery, Bind 133, Nr. 5, 2020, s. 1548–1558.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Intracranial pressure before and after cranioplasty
T2 - insights into intracranial physiology
AU - Lilja-Cyron, Alexander
AU - Andresen, Morten
AU - Kelsen, Jesper
AU - Andreasen, Trine Hjorslev
AU - Petersen, Lonnie Grove
AU - Fugleholm, Kåre
AU - Juhler, Marianne
PY - 2020
Y1 - 2020
N2 - OBJECTIVE: Decompressive craniectomy (DC) is an emergency neurosurgical procedure used in cases of severe intracranial hypertension or impending intracranial herniation. The procedure is often lifesaving, but it exposes the brain to atmospheric pressure in the subsequent rehabilitation period, which changes intracranial physiology and probably leads to complications such as hydrocephalus, hygromas, and "syndrome of the trephined." The objective of the study was to study the effect of cranioplasty on intracranial pressure (ICP), postural ICP changes, and intracranial pulse wave amplitude (PWA).METHODS: The authors performed a prospective observational study including patients who underwent DC during a 12-month period. Telemetric ICP sensors were implanted in all patients at the time of DC. ICP was evaluated before and after cranioplasty during weekly measurement sessions including a standardized postural change program.RESULTS: Twelve of the 17 patients enrolled in the study had cranioplasty performed and were included in the present investigation. Their mean ICP in the supine position increased from -0.5 +/- 4.8 mm Hg the week before cranioplasty to 6.3 +/- 2.5 mm Hg the week after cranioplasty (p <0.0001), whereas the mean ICP in the sitting position was unchanged (-1.2 +/- 4.8 vs -1.1 +/- 3.6 mm Hg, p = 0.90). The difference in ICP between the supine and sitting positions was minimal before cranioplasty (1.1 +/- 1.8 mm Hg) and increased to 7.4 +/- 3.6 mm Hg in the week following cranioplasty (p <0.0001). During the succeeding 2 weeks of the follow-up period, the mean ICP in the supine and sitting positions decreased in parallel to, respectively, 4.6 +/- 3.0 mm Hg (p = 0.0003) and -3.9 +/- 2.7 mm Hg (p = 0.040), meaning that the postural ICP difference remained constant at around 8 mm Hg. The mean intracranial PWA increased from 0.7 +/- 0.7 mm Hg to 2.9 +/- 0.8 mm Hg after cranioplasty (p <0.0001) and remained around 3 mm Hg throughout the following weeks.CONCLUSIONS: Cranioplasty restores normal intracranial physiology regarding postural ICP changes and intracranial PWA. These findings complement those of previous investigations on cerebral blood flow and cerebral metabolism in patients after decompressive craniectomy.
AB - OBJECTIVE: Decompressive craniectomy (DC) is an emergency neurosurgical procedure used in cases of severe intracranial hypertension or impending intracranial herniation. The procedure is often lifesaving, but it exposes the brain to atmospheric pressure in the subsequent rehabilitation period, which changes intracranial physiology and probably leads to complications such as hydrocephalus, hygromas, and "syndrome of the trephined." The objective of the study was to study the effect of cranioplasty on intracranial pressure (ICP), postural ICP changes, and intracranial pulse wave amplitude (PWA).METHODS: The authors performed a prospective observational study including patients who underwent DC during a 12-month period. Telemetric ICP sensors were implanted in all patients at the time of DC. ICP was evaluated before and after cranioplasty during weekly measurement sessions including a standardized postural change program.RESULTS: Twelve of the 17 patients enrolled in the study had cranioplasty performed and were included in the present investigation. Their mean ICP in the supine position increased from -0.5 +/- 4.8 mm Hg the week before cranioplasty to 6.3 +/- 2.5 mm Hg the week after cranioplasty (p <0.0001), whereas the mean ICP in the sitting position was unchanged (-1.2 +/- 4.8 vs -1.1 +/- 3.6 mm Hg, p = 0.90). The difference in ICP between the supine and sitting positions was minimal before cranioplasty (1.1 +/- 1.8 mm Hg) and increased to 7.4 +/- 3.6 mm Hg in the week following cranioplasty (p <0.0001). During the succeeding 2 weeks of the follow-up period, the mean ICP in the supine and sitting positions decreased in parallel to, respectively, 4.6 +/- 3.0 mm Hg (p = 0.0003) and -3.9 +/- 2.7 mm Hg (p = 0.040), meaning that the postural ICP difference remained constant at around 8 mm Hg. The mean intracranial PWA increased from 0.7 +/- 0.7 mm Hg to 2.9 +/- 0.8 mm Hg after cranioplasty (p <0.0001) and remained around 3 mm Hg throughout the following weeks.CONCLUSIONS: Cranioplasty restores normal intracranial physiology regarding postural ICP changes and intracranial PWA. These findings complement those of previous investigations on cerebral blood flow and cerebral metabolism in patients after decompressive craniectomy.
KW - cerebrospinal fluid
KW - cranioplasty
KW - decompressive craniectomy
KW - intracranial pressure
KW - telemetry
KW - traumatic brain injury
KW - trauma
KW - DECOMPRESSIVE CRANIECTOMY
KW - PERFUSION
KW - ICP
KW - FEASIBILITY
KW - GUIDELINES
KW - MANAGEMENT
KW - INFARCTION
KW - STATEMENT
KW - HEALTHY
KW - SKULL
U2 - 10.3171/2019.7.JNS191077
DO - 10.3171/2019.7.JNS191077
M3 - Journal article
C2 - 31628275
VL - 133
SP - 1548
EP - 1558
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
SN - 0022-3085
IS - 5
ER -
ID: 252726749