gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Intraoperative decrease in ICP throughout the course of decompressive hemicraniectomy and durotomy operation in trauma patients

Meeting Abstract

  • R.B. Moringlane - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen
  • R. Burger - Neurochirurgische Klinik, Krankenhaus Nordstadt, Klinikum Region Hannover GmbH; <P></P>
  • N. Keric - Neurochirurgische Universitätsklinik Mainz
  • F. Stockhammer - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen
  • K.V. Eckardstein - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen
  • D. Duncker - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen
  • V. Rohde - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 010

DOI: 10.3205/12dgnc397, URN: urn:nbn:de:0183-12dgnc3972

Published: June 4, 2012

© 2012 Moringlane et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Decompressive hemicraniectomy has been proven to be an effective method to lower intracranial pressure (ICP). Patients with increased ICP of different etiology may benefit in terms of survival and quality of life. The aim of this presentation is to illustrate the immediate results of decompressive craniotomy and durotomy in trauma patients with an intraparencymal ICP monitor in place. Durotomy is easier and faster to perform than other decompressive procedures as duroplasties and thus saves precious time.

Methods: Patients who initially received an intraparencymal ICP monitor (Codman) to optimize conservative treatment following head trauma and who underwent decompressive craniectomy in the further course of treatment for uncontrolled increase in ICP were included. During the procedure ICP was continuously measured and recorded at the following procedural steps: At the time of (1) skin incision, (2) after placement of every bur hole, (3) after removing the skull flap, (4) after the incisions of the dura, (5) at the time of skin closure, and (6) after removing of the Mayfield clamp. The middle arterial pressure (mmHg) and the arterial pCO2 (mmHg) were noted as well at the same time of above mentioned steps of the procedure.

Results: Altogether 16 patients have been included. The mean ICP with standard deviation at the time of skin incision (1) was 40 ± 16 mmHg, after placement of burr holes and removal of bone flap (3) 19 ± 10 mmHg, and after durotomy (4) 9 ± 4 mmHg. The differences in ICP at skin incision and at the time of bone flap removal as well as at durotomy were significant, respectively (p < 0.005). The middle arterial pressure and arterial pCO2 did not change essentially.

Conclusions: With the presented data we were able to show a continuous decrease in ICP throughout the course of the decompressive craniectomy. Interestingly, but not quite unexpectedly, craniectomy without durotomy already yielded a dramatic decrease in ICP. On the basis of these data one can only speculate whether durotomy or even duroplasty is in fact needed for a substantial control of elevated ICP; possibly, one can abandon durotomy as an additional, potentially harmful procedure that makes replacement of bone flaps more difficult due to cortical scarring.