Intracranial pressure changes at perioperative period in patients with large hemispheric infarction after standard large bone flap decompression
10.3760/cma.j.cn115354-20240522-00309
- VernacularTitle:大脑半球大面积梗死患者标准大骨瓣减压术围手术期颅内压变化研究
- Author:
Yulong GUO
1
;
Fandong MENG
;
Yongfei LI
;
Yuanyuan MA
;
Yushe WANG
Author Information
1. 郑州大学人民医院神经外科，郑州 450003
- Keywords:
Large hemispheric infarction;
Standard large bone flap decompression;
Intracranial pressure
- From:
Chinese Journal of Neuromedicine
2024;23(6):578-584
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the correlations of neurological function recovery and intraoperative bone window parameters with intracranial pressure (ICP) changes at perioperative period in patients with large hemispheric infarction (LHI) after standard large bone flap decompression.Methods:Forty LHI patients accepted standard large bone flap decompression in Department of Neurosurgery, People's Hospital of Zhengzhou University from December 2020 to December 2023 were enrolled. ICP was measured before decompression, at the time of bone flap removal, during dural opening, and 24 h after decompression. Correlations of National Institutes of Health Stroke Scale (NIHSS), Extended Glasgow Outcome Scale (GOSE) and Glasgow Coma Scale (GCS) score changes, length and area of the bone window, bone window area/cranial bone area, infarct brain tissue volume/brain tissue volume with ICP changes were analyzed by Pearson's correlation. Length and area of bone window in patients with good neurological function recovery (NIHSS score decreased by≥5, GOSE score increased by≥3, or GCS score increased by≥3 before and after decompression) were calculated.Results:ICP at the time of bone flap removal, during dural opening, and 24 h after decompression was significantly lower than that before decompression ( P<0.05); ICP at the time of bone flap removal was higher than that at 24 h after decompression and during dural opening. Reduction between ICP before decompression and that during dural opening was more obvious than ICP reduction before and 24 h after decompression and ICP reduction before decompression and at the time of bone flap removal, with significant differences ( P<0.05). Postoperative NIHSS scores were significantly lower than preoperative ones ( P<0.05), and both postoperative GOSE and GCS scores were significantly higher than preoperative ones ( P<0.05). Decrease of NIHSS score, increase of GOSE and GCS scores before and after decompression were positively correlated with ICP reduction before and 24 h after decompression ( r=0.386, P=0.018; r=0.411, P=0.033; r=0.319, P=0.037); length and area of the bone window were positively correlated with ICP reduction before and 24 h after decompression ( r=0.461, P=0.028; r=0.536, P=0.034); bone window area/cranial bone area was positively correlated with ICP reduction before and 24 h after decompression ( r=0.438, P=0.027), while infarct brain tissue volume/brain tissue volume was negatively correlated with ICP reduction before and 24 h after decompression ( r=-0.371, P=0.031). Of the 40 patients, 25 had good neurological function recovery after decompression, with length of the bone window ranged 12.3-16.7 cm and area of the bone window ranged 54.5-91.9 cm 2. Conclusion:Standard large bone flap decompression can reduce ICP and improve prognosis in LHI patients; intraoperative bone window parameters are obviously correlated with ICP reduction before and 24 h after decompression; length of the bone window ranged 12.3-16.7 cm and area of the bone window ranged 54.5-91.9 cm 2 are suggested for decompression.
