scholarly journals Complete hemispheric exposure vs. superior sagittal sinus sparing craniectomy: incidence of shear-bleeding and shunt-dependency

2021 ◽  
Author(s):  
Martin Vychopen ◽  
Matthias Schneider ◽  
Valeri Borger ◽  
Patrick Schuss ◽  
Charlotte Behning ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Superior Sagittal Sinus ◽  
Ct Scans ◽  
Raised Intracranial Pressure ◽  
Elevated Intracranial Pressure ◽  
Decompressive Hemicraniectomy ◽  
Sagittal Sinus ◽  
Significant Difference ◽  
Outcome Difference ◽  
Shunt Dependency

Abstract Purpose Decompressive hemicraniectomy (DC) has been established as a standard therapeutical procedure for raised intracranial pressure. However, the size of the DC remains unspecified. The aim of this study was to analyze size related complications following DC. Methods Between 2013 and 2019, 306 patients underwent DC for elevated intracranial pressure at author´s institution. Anteroposterior and craniocaudal DC size was measured according to the postoperative CT scans. Patients were divided into two groups with (1) exposed superior sagittal sinus (SE) and (2) without superior sagittal sinus exposure (SC). DC related complications e.g. shear-bleeding at the margins of craniectomy and secondary hydrocephalus were evaluated and compared. Results Craniectomy size according to anteroposterior diameter and surface was larger in the SE group; 14.1 ± 1 cm vs. 13.7 ± 1.2 cm, p = 0.003, resp. 222.5 ± 40 cm2 vs. 182.7 ± 36.9 cm2, p < 0.0001. The SE group had significantly lower rates of shear-bleeding: 20/176 patients; (11%), compared to patients of the SC group; 36/130 patients (27%), p = 0.0003, OR 2.9, 95% CI 1.6–5.5. There was no significant difference in the incidence of shunt-dependent hydrocephalus; 19/130 patients (14.6%) vs. 24/176 patients (13.6%), p = 0.9. Conclusions Complete hemispheric exposure in terms of DC with SE was associated with significantly lower levels of iatrogenic shear-bleedings compared to a SC-surgical regime. Although we did not find significant outcome difference, our findings suggest aggressive craniectomy regimes including SE to constitute the surgical treatment strategy of choice for malignant intracranial pressure.

scholarly journals The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature

2014 ◽  
Vol 14 (6) ◽  
pp. 674-681 ◽  
Author(s):  
Steven A. Wall ◽  
Gregory P. L. Thomas ◽  
David Johnson ◽  
Jo C. Byren ◽  
Jayaratnam Jayamohan ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Nonoperative Management ◽  
Raised Intracranial Pressure ◽  
Corrective Surgery ◽  
Icp Monitoring ◽  
Noninvasive Method ◽  
Radiological Findings ◽  
Indication For Surgery ◽  
Sagittal Craniosynostosis ◽  
Significant Difference

Object The presence of raised intracranial pressure (ICP) in untreated nonsyndromic, isolated sagittal craniosynostosis (SC) is an important functional indication for surgery. Methods A retrospective review was performed of all 284 patients presenting with SC to the Oxford Craniofacial Unit between 1995 and 2010. Results Intraparenchymal ICP monitoring was performed in 39 children following a standard unit protocol. Monitoring of ICP was offered for all patients in whom nonoperative management was considered on the basis of minimal deformity or in cases in which parents were reluctant to agree to corrective surgery. These patients presented at an older age than the rest of the cohort (mean age 56 months), with marked scaphocephaly (16/39, 41%), mild scaphocephaly (11, 28%), or no scaphocephalic deformity (12, 31%). Raised ICP was found in 17 (44%) patients, with no significant difference in its incidence among the 3 different deformity types. Raised ICP was not predicted by the presence of symptoms of ICP or developmental delay or by ophthalmological or radiological findings. Conclusions The incidence of raised ICP in SC reported here is greater than that previously published in the literature. The lack of a reliable noninvasive method to identify individuals with elevated ICP in SC mandates consideration of intraparenchymal ICP monitoring in all patients for whom nonoperative management is contemplated.

The pseudodelta sign in acute head trauma

1988 ◽  
Vol 69 (6) ◽  
pp. 867-868 ◽  
Author(s):  
Joel W. Yeakley ◽  
John S. Mayer ◽  
Larry L. Patchell ◽  
K. Francis Lee ◽  
Michael E. Miner
Keyword(s):  
Head Trauma ◽  
Superior Sagittal Sinus ◽  
Ct Scans ◽  
Content Type ◽  
Sagittal Sinus ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Triangular Area ◽  
Fine Print

✓ The “delta sign” is a triangular area of high density with a low-density center seen on contrast-enhanced computerized tomography (CT) scans in the location of the superior sagittal sinus. It indicates thrombosis of the sinus. The authors describe the “pseudodelta sign,” which is similar but is seen on non-contrast-enhanced CT scans and which has a high correlation with hemorrhage secondary to acute head trauma.

Doppler ultrasound measurements of superior sagittal sinus blood velocity

1972 ◽  
Vol 37 (3) ◽  
pp. 312-315 ◽  
Author(s):  
Ronald Brisman ◽  
Sadek K. Hilal ◽  
Michael Tenner
Keyword(s):  
Intracranial Pressure ◽  
Superior Sagittal Sinus ◽  
Mass Effect ◽  
Blood Velocity ◽  
Doppler Measurement ◽  
Content Type ◽  
Sagittal Sinus ◽  
The Mean ◽  
Sagittal Sinus Occlusion ◽  
The Relationship

✓ Transcutaneous Doppler recordings from the patent anterior fontanel were used to measure superior sagittal sinus blood velocity (SSSV). In 15 cases it ranged from 4.5 to 18.1 cm/sec. In five of these patients with no mass effect and normal intracranial pressure, the mean SSSV was 13.6 cm/sec. An independent arteriographic measurement of SSSV was 4.5 cm/sec in a hydrocephalic patient with elevated intracranial pressure whose Doppler measurement of SSSV was 6.6 cm/ sec. The Doppler technique may be used to diagnose sagittal sinus occlusion. SSSV tended to be low when CSF pressure was elevated, but the relationship was not constant.

Acquired Anterior Basal Encephalocele in Idiopathic Hypertrophic Pachymeningitis

2008 ◽  
Vol 21 (6) ◽  
pp. 791-794 ◽  
Author(s):  
C. Singh ◽  
C. Kesavadas ◽  
M.D. Nair ◽  
C. Sarada
Keyword(s):  
Intracranial Pressure ◽  
Sinus Thrombosis ◽  
Cribriform Plate ◽  
Dural Sinus ◽  
Raised Intracranial Pressure ◽  
Elevated Intracranial Pressure ◽  
Dural Sinus Thrombosis ◽  
Hypertrophic Pachymeningitis ◽  
Ethmoid Bone ◽  
Basal Encephalocele

This report describes a 49-year-old woman diagnosed as idiopathic hypertrophic pachymeningitis (IHCPM) with imaging evidence of diffuse dural sinus thrombosis. Over the years, secondary to the raised intracranial pressure, she had developed an anterior basal encephalocele through the defects in the cribriform plate of the ethmoid bone. The relation between elevated intracranial pressure and encephalocele is discussed.

Site and mechanism for compression of the venous system during experimental intracranial hypertension

1974 ◽  
Vol 41 (4) ◽  
pp. 427-434 ◽  
Author(s):  
Yoku Nakagawa ◽  
Mitsuo Tsuru ◽  
Kenzoh Yada
Keyword(s):  
Blood Pressure ◽  
Intracranial Pressure ◽  
Pressure Gradient ◽  
Superior Sagittal Sinus ◽  
Venous Pressure ◽  
Systemic Blood Pressure ◽  
Intraluminal Pressure ◽  
Systemic Blood ◽  
Sagittal Sinus ◽  
Bridging Vein

✓ The pressure gradient of the venous pathway between the cortical vein and superior sagittal sinus was measured in adult mongrel dogs by recording the pressures of the bridging vein, lateral lacuna (proximal portion), and superior sagittal sinus, together with the systemic blood pressure while gradually increasing the intracranial pressure up to the level of mean systemic blood pressure. The pressure gradient between the lateral lacuna and the superior sagittal sinus was also measured under increased intracranial pressure. Pressures of the bridging vein and lateral lacuna were constantly 50 to 250 mm H2O higher than the intracranial pressure, regardless of the level of intracranial pressure. An abrupt drop in the intraluminal pressure was observed at a point 1 to 2 mm proximal to the junction of the lateral lacuna and the superior sagittal sinus, regardless of the level of intracranial pressure. It is concluded that gradual stenosis of the parasagittal venous pathways took place 1 to 2 mm proximal to the junction between the lacuna and the superior sagittal sinus, and thus cortical venous pressure was maintained 50 to 250 mm H2O higher than intracranial pressure. The authors believe that an “intracranial venous pressure regulation mechanism” exists at the junction of the lateral lacuna and the superior sagittal sinus.

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