TY - JOUR

T1 - Long-Term Effect of Decompressive Craniectomy on Intracranial Pressure and Possible Implications for Intracranial Fluid Movements

AU - Lilja-Cyron, Alexander

AU - Andresen, Morten

AU - Kelsen, Jesper

AU - Andreasen, Trine Hjorslev

AU - Fugleholm, Kåre

AU - Juhler, Marianne

N1 - Copyright © 2019 by the Congress of Neurological Surgeons.

PY - 2020

Y1 - 2020

N2 - BACKGROUND: Decompressive craniectomy (DC) is used in cases of severe intracranial hypertension or impending intracranial herniation. DC effectively lowers intracranial pressure (ICP) but carries a risk of severe complications related to abnormal ICP and/or cerebrospinal fluid (CSF) circulation, eg, hygroma formation, hydrocephalus, and "syndrome of the trephined."OBJECTIVE: To study the long-term effect of DC on ICP, postural ICP regulation, and intracranial pulse wave amplitude (PWA).METHODS: Prospective observational study including patients undergoing DC during a 12-mo period. Telemetric ICP sensors (Neurovent-P-tel; Raumedic, Helmbrechts, Germany) were implanted in all patients. Following discharge from the neuro intensive care unit (NICU), scheduled weekly ICP monitoring sessions were performed during the rehabilitation phase.RESULTS: A total of 16 patients (traumatic brain injury: 7, stroke: 9) were included (median age: 55 yr, range: 19-71 yr). Median time from NICU discharge to cranioplasty was 48 d (range: 16-98 d) and during this period, mean ICP gradually decreased from 7.8 ± 2.0 mm Hg to -1.8 ± 3.3 mm Hg (P = .02). The most pronounced decrease occurred during the first month. Normal postural ICP change was abolished after DC for the entire follow-up period, ie, there was no difference between ICP in supine and sitting position (P = .67). PWA was markedly reduced and decreased from initially 1.2 ± 0.7 mm Hg to 0.4 ± 0.3 mm Hg (P = .05).CONCLUSION: Following NICU discharge, ICP decreases to negative values within 4 wk, normal postural ICP regulation is lost and intracranial PWA is diminished significantly. These abnormalities might have implications for intracranial fluid movements (eg, CSF and/or glymphatic flow) following DC and warrants further investigations.

AB - BACKGROUND: Decompressive craniectomy (DC) is used in cases of severe intracranial hypertension or impending intracranial herniation. DC effectively lowers intracranial pressure (ICP) but carries a risk of severe complications related to abnormal ICP and/or cerebrospinal fluid (CSF) circulation, eg, hygroma formation, hydrocephalus, and "syndrome of the trephined."OBJECTIVE: To study the long-term effect of DC on ICP, postural ICP regulation, and intracranial pulse wave amplitude (PWA).METHODS: Prospective observational study including patients undergoing DC during a 12-mo period. Telemetric ICP sensors (Neurovent-P-tel; Raumedic, Helmbrechts, Germany) were implanted in all patients. Following discharge from the neuro intensive care unit (NICU), scheduled weekly ICP monitoring sessions were performed during the rehabilitation phase.RESULTS: A total of 16 patients (traumatic brain injury: 7, stroke: 9) were included (median age: 55 yr, range: 19-71 yr). Median time from NICU discharge to cranioplasty was 48 d (range: 16-98 d) and during this period, mean ICP gradually decreased from 7.8 ± 2.0 mm Hg to -1.8 ± 3.3 mm Hg (P = .02). The most pronounced decrease occurred during the first month. Normal postural ICP change was abolished after DC for the entire follow-up period, ie, there was no difference between ICP in supine and sitting position (P = .67). PWA was markedly reduced and decreased from initially 1.2 ± 0.7 mm Hg to 0.4 ± 0.3 mm Hg (P = .05).CONCLUSION: Following NICU discharge, ICP decreases to negative values within 4 wk, normal postural ICP regulation is lost and intracranial PWA is diminished significantly. These abnormalities might have implications for intracranial fluid movements (eg, CSF and/or glymphatic flow) following DC and warrants further investigations.

KW - Adult

KW - Aged

KW - Brain Injuries, Traumatic/epidemiology

KW - Decompressive Craniectomy/adverse effects

KW - Female

KW - Follow-Up Studies

KW - Germany/epidemiology

KW - Humans

KW - Intensive Care Units/trends

KW - Intracranial Hypertension/epidemiology

KW - Intracranial Pressure/physiology

KW - Male

KW - Middle Aged

KW - Monitoring, Physiologic/trends

KW - Prospective Studies

KW - Prostheses and Implants/adverse effects

KW - Stroke/epidemiology

U2 - 10.1093/neuros/nyz049

DO - 10.1093/neuros/nyz049

M3 - Journal article

C2 - 30768137

VL - 86

SP - 231

EP - 240

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 2

ER -