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 -