POSTOPERATIVE HYDROCEPHALUS IN PATIENTS UNDERGOING DECOMPRESSIVE HEMICRANIECTOMY FOR ISCHEMIC OR HEMORRHAGIC STROKE

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 489-494 ◽  
Author(s):  
Allen Waziri ◽  
David Fusco ◽  
Stephan A. Mayer ◽  
Guy M. McKhann ◽  
E. Sander Connolly
Keyword(s):  
Intracranial Pressure ◽  
Hemorrhagic Stroke ◽  
Communicating Hydrocephalus ◽  
Imaging Data ◽  
Decompressive Hemicraniectomy ◽  
Pressure Dynamics ◽  
Csf Diversion ◽  
Postoperative Hydrocephalus ◽  
Early Cranioplasty ◽  
Persistent Hydrocephalus

Abstract OBJECTIVE We have frequently observed the development of postoperative communicating hydrocephalus in patients undergoing decompressive hemicraniectomy. This condition may persist in some patients after cranioplasty and require permanent cerebrospinal fluid (CSF) diversion. To confirm an independent correlation between hemicraniectomy and the development of communicating hydrocephalus, and to detail the frequency and potential clinical factors contributing to this complication, we evaluated our series of patients undergoing hemicraniectomy for life-threatening increases in intracranial pressure secondary to ischemic or hemorrhagic stroke. METHODS A retrospective analysis was performed with a cohort of consecutive patients who underwent emergent hemicraniectomy for medically refractory elevations in intracranial pressure. Patients with known independent risk factors for the development of communicating hydrocephalus were excluded. Clinical and imaging data were reviewed to determine the incidence and type of hydrocephalus after hemicraniectomy, the persistence of hydrocephalus after cranioplasty, and the need for permanent CSF diversion. RESULTS Eighty-eight percent of the eligible patients undergoing hemicraniectomy in our cohort developed postoperative communicating hydrocephalus. Half of these patients harbored persistent hydrocephalus after cranioplasty and required placement of a ventriculoperitoneal shunt. We noted a strong correlation between prolonged time to replacement of the bone flap and persistence of hydrocephalus. CONCLUSION Communicating hydrocephalus is an almost universal finding in patients after hemicraniectomy. Delayed time to cranioplasty is linked with the development of persistent hydrocephalus, necessitating permanent CSF diversion in some patients. We propose that early cranioplasty, when possible, may restore normal intracranial pressure dynamics and prevent the need for permanent CSF diversion in patients after hemicraniectomy.

Modeling Of Intracranial Pressure Dynamics

2005 ◽  
Author(s):  
R.L. Griffith ◽  
H.G. Sullivan ◽  
J.D. Miller
Keyword(s):  
Intracranial Pressure ◽  
Pressure Dynamics

Abstract T P405: Improvement in Midline Shift is Associated with Survival After Decompressive HemiCraniectomy in Large Hemispheric Infarctions

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Joanna I Ramiro ◽  
Rajat Dhar ◽  
Eli Feen ◽  
Abhay Kumar
Keyword(s):  
Hospital Mortality ◽  
Care Facility ◽  
Imaging Data ◽  
Midline Shift ◽  
Term Care ◽  
Nihss Score ◽  
Decompressive Hemicraniectomy ◽  
Long Term Care Facility ◽  
Risk Of Death ◽  
Neuro Imaging

Background and Purpose: It remains uncertain which patients with malignant edema after large hemispheric infarction (LHI) remain at risk of death despite decompressive hemicraniectomy (DHC). We investigated factors associated with in-hospital mortality in a cohort of patients with LHI who underwent DHC. Methodology: This retrospective cohort study conducted over a five-year period identified 24 LHI patients who underwent DHC. Patient demographics, pre- and post-DHC clinical and neuro-imaging data were recorded (including midline shift [MLS] at the level of lateral ventricles). These variables were then analyzed in relation to in-hospital mortality. Results: Patients were predominantly male (17/24), with mean age of 55±15 years and baseline NIHSS score of 18.5± 4. Despite DHC, performed at a median of 52 hours, mortality still occurred in 9 patients (38%), with 11 (46%) going to acute rehabilitation and remainder to long-term care facility (LTC). Patients had a mean pre-operative MLS of 11 ± 3 mm. When compared with a head CT obtained 48 hours after DHC, MLS improved the most in patients going to rehabilitation (by 6 ± 4.2 mm), compared to those going to LTC (3.2 ± 5 mm), while the least improvement was seen in those who died (1 ± 5 mm). Survivors had significant improvement in MLS (5.3 ± 4.4 mm) compared to the non-survivors (1 ± 5 mm), p = 0.04. The survivors were also significantly younger (50 ± 17 years) compared to those who died (62 ± 7 years). Thirteen patients (54% of the cohort) received intracranial pressure (ICP) monitors ipsilateral to the infarct during DHC but measured ICPs were statistically similar in survivors vs non-survivors. Other variables (baseline NIHSS score, MLS and time to surgery) did not predict death in the cohort. Conclusion: Mortality remains high in LHI patients even after DHC. Improvement in MLS after DHC appears to separate survivors from non-survivors while post-DHC ICPs do not. However, our sample size is small and additional studies with larger population sizes are required for validation of our findings.

scholarly journals Acetazolamide Mitigates Intracranial Pressure Spikes Without Affecting Functional Outcome After Experimental Hemorrhagic Stroke

2018 ◽  
Vol 10 (4) ◽  
pp. 428-439 ◽  
Author(s):  
Michael R. Williamson ◽  
Cassandra M. Wilkinson ◽  
Kristen Dietrich ◽  
Frederick Colbourne
Keyword(s):  
Intracranial Pressure ◽  
Functional Outcome ◽  
Hemorrhagic Stroke

Abstract TMP15: Contralateral Hemispheric Atrophy After Major Hemispheric Infarction

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Austin A Barnett ◽  
Warren Selman ◽  
Cathy Sila
Keyword(s):  
Communicating Hydrocephalus ◽  
Cerebral Peduncle ◽  
Contralateral Hemisphere ◽  
Midline Shift ◽  
Ipsilateral Hemisphere ◽  
Decompressive Hemicraniectomy ◽  
Functional Reorganization ◽  
The Mean ◽  
Hemispheric Infarction

Objective: Atrophy of the ipsilateral hemisphere, cerebral peduncle, and contralateral cerebellum predict outcome after stroke; little is known of the effect of stroke on the contralateral hemisphere although it plays an important role in functional reorganization. Methods: All patients who underwent decompressive hemicraniectomy for malignant hemispheric infarction at UH-CMC between 1/2003-12/2009 were analyzed with IRB approval. Patients with adequate CT scans both prior to surgery and after reconstructive cranioplasty were included; those with communicating hydrocephalus, confounding lesions or ≥ 10 mm of midline shift were excluded. Brainlab iPlan® software (Germany) was used to manually trace the infarct, non-infarct ipsilateral and contralateral hemisphere on axial, sagittal and coronal slices. Results: Of 30 patients, 9 met inclusion criteria. The inter-rater reliability of volumetric analyses was excellent (r=0.99). The mean contralateral hemisphere volume at follow-up was significantly reduced compared to the baseline study (465.987 ± 78.32 cc vs 493.429 ±76.92 cc, p< 0.0001, Fisher’s two-tailed t-test ). Contralateral hemispheric atrophy was identified in all patients (mean 27.441 cc, range 4.985 - 42.807 cc) and represented a loss of 5.7% (1.2 - 11.16%) of the original volume. Contralateral hemispheric atrophy was significantly related to the volume of the infarct and the time from stroke onset to decompressive hemicraniectomy but not to the extent of midline shift on the post-operative scan nor <10 mm on the pre-operative scan. Contralateral hemispheral atrophy was identified early and not related to the length of follow-up (median 4.5, range 2-43 months). Conclusions: Contralateral hemispheric atrophy occurs within months of major hemispheral infarction and is related to infarct size and the time to decompressive hemicraniectomy.

scholarly journals Invasive Monitoring of Intracranial Pressure After Decompressive Craniectomy in Malignant Stroke

Stroke ◽  
2020 ◽  
Author(s):  
Silvia Hernández-Durán ◽  
Leonie Meinen ◽  
Veit Rohde ◽  
Christian von der Brelie
Keyword(s):  
Intracranial Pressure ◽  
Mortality Rate ◽  
Operating Characteristic ◽  
Receiver Operating Characteristic Analysis ◽  
High Specificity ◽  
Invasive Monitoring ◽  
Icp Monitoring ◽  
Characteristic Analysis ◽  
Decompressive Hemicraniectomy

Background and Purpose: The role of decompressive hemicraniectomy (DC) in malignant cerebral infarction (MCI) has clearly been established, but little is known about the course of intracranial pressure (ICP) in patients undergoing this surgical measure. In this study, we investigated the role of invasive ICP monitoring in patients after DC for MCI, postulating that postoperative ICP predicts mortality. Methods: In this retrospective observational study of MCI patients undergoing DC, ICP were recorded continuously in hourly intervals for the first 72 hours after DC. For every hour, mean ICP was calculated, pooling ICP of every patient. A receiver operating characteristic analysis was performed for hourly mean ICP. A subgroup analysis by age (≥60 years and <60 years) was also performed. Results: A total of 111 patients were analyzed, with 29% mortality rate in patients <60 years, and 41% in patients ≥60 years. A threshold of 10 mm Hg within the first 72 postoperative hours was a reliable predictor of mortality in MCI, with an acceptable sensitivity of 70% and high specificity of 97%. Established predictors of mortality failed to predict mortality. Conclusions: Our study suggests the need to reevaluate postoperative ICP after DC in MCI and calls for a redefinition of ICP thresholds in these patients to indicate further therapy.

Raised intracranial pressure, cerebral oedema, and hydrocephalus

2011 ◽  
Author(s):  
Ian Whittle
Keyword(s):  
Intracranial Pressure ◽  
Dynamic Equilibrium ◽  
Venous Pressure ◽  
Venous Blood ◽  
Contributory Factor ◽  
Common Disease ◽  
Brain Vessels ◽  
Arterial Blood ◽  
Pressure Dynamics ◽  
The Brain

The brain is protected by the cranial skeleton. Within the intracranial compartment are also cerebrospinal fluid, CSF, and the blood contained within the brain vessels. These intracranial components are in dynamic equilibrium due to the pulsations of the heart and the respiratory regulated return of venous blood from the brain. Normally the mean arterial blood pressure, systemic venous pressure, and brain volume are regulated to maintain physiological values for intracranial pressure, ICP. There are a range of very common disorders such as stroke, and much less common, such as idiopathic intracranial hypertension, that are associated with major disturbances of intracranial pressure dynamics. In some of these the contribution to pathophysiology is relatively minor whereas in others it may be substantial and be a major contributory factor to morbidity or even death.Intracranial pressure can be disordered because of brain oedema, disturbances in CSF flow, mass lesions, and vascular engorgement of the brain. Each of these may have variable causes and there may be interactions between mechanisms. In this chapter the normal regulation of intracranial pressure is outlined and some common disease states in clinical neurological practice that are characterized by either primary or secondary problems in intracranial pressure dynamics described.

scholarly journals Intracranial Pressure Dynamics and Cerebral Vasomotor Reactivity in Coronavirus Disease 2019 Patient With Acute Encephalitis

2020 ◽  
Vol 2 (8) ◽  
pp. e0197 ◽  
Author(s):  
Teodor Svedung Wettervik ◽  
Eva Kumlien ◽  
Elham Rostami ◽  
Timothy Howells ◽  
Magnus von Seth ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Vasomotor Reactivity ◽  
Acute Encephalitis ◽  
Cerebral Vasomotor Reactivity ◽  
Pressure Dynamics
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