Artikel
Brainstem cavernous malformation (CCM) – intensive care therapy and relevance for hospitalisation
Hirnstamm-Kavernome – intensivmedizinische Aspekte und Relevanz für den Krankenhausaufenthalt
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Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: To estimate different aspects of postoperative intensive care therapy and complicated course in patients with a brainstem cavernous malformation. To examine duration of hospitalization, possible complications and relevance of location of brainstem cavernous malformation (CCM).
Methods: 87 cases of brainstem CCM, who have been treated surgically between 2008 and 2018, were observed for postoperative course and complications: Duration of hospitalization/ intensive care therapy, need of reintubation/ tracheostomy, occur of pneumonia, possibility of discharge home or transfer to a rehabilitation clinic. Descriptive analysis was accordingly performed. Impact of CCM location was examined with logistic regression analysis.
Results: Average duration of hospitalization was 18,2 days (2- 64) in total, 3,93 days (0-36) in the intensive care unit and 1,49 days (0-32) in the intermediate care unit. 7 patients suffered from respiratory failure and required reintubation postoperatively, 5 received a tracheostomy, 6 suffered from pneumonia (4 with tracheostomy). 41 patients were discharged home, while 41 were send to another clinic/ rehabilitation clinic directly. CCM were located in one (or multiple) parts of the brainstem, 55 in the pons, 27 in the mesencephalon, 14 in the medulla oblongata and 7 in the thalamus.A CCM located in the pons or medulla oblongata provoked a more complicated postoperative course with longer hospitalization and worse functional outcome (mRS). These locations also significantly correlated with impaired functional outcome (mRS >1) (medulla p=0,04, pons p=0,004). Need for reintubation and tracheostomy was almost exclusively found in cases with CCM located in the pons or medulla oblongata. However, statistical significance was only seen for medulla oblongata location (p=0,048).
Conclusion: Patients with brainstem cavernoma and surgical therapy typically need a special postoperative care. ICU course and complications depend on the specific location in brainstem.