Forskning
Udskriv Udskriv
Switch language
Rigshospitalet - en del af Københavns Universitetshospital
Udgivet

Intracranial pressure before and after cranioplasty: insights into intracranial physiology

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

  1. Skull base versus non-skull base meningioma surgery in the elderly

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Ethical difficulties in the innovative surgical treatment of patients with recurrent glioblastoma multiforme

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Bilateral chronic subdural hematoma: unilateral or bilateral drainage?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Vascular permeability and iron deposition biomarkers in longitudinal follow-up of cerebral cavernous malformations

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. B waves: a systematic review of terminology, characteristics, and analysis methods

    Publikation: Bidrag til tidsskriftReviewForskningpeer review

  2. Aneurismal subaraknoidalblødning

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Vis graf over relationer

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.

OriginalsprogEngelsk
TidsskriftJournal of Neurosurgery
Sider (fra-til)1-11
Antal sider11
ISSN0022-3085
DOI
StatusUdgivet - 18 okt. 2019

ID: 58306175