Application of dynamic intracranial pressure monitoring in suboccipital
decompressive craniectomy for space-occupying cerebellar infarction

doi:10.3760/cma.j.issn.1007-1245.2022.09.023

Abstract

Abstract: Objective　To explore the application of dynamic intracranial pressure (ICP) monitoring in suboccipital decompressive craniectomy (SDC) for space-occupying cerebellar infarction, and investigate the ICP changes and their impact on the patients' prognosis. Methods　Twenty-two patients with space-occupying cerebellar infarction treated with SDC and dynamic ICP monitoring in Heze Municipal Hospital from October 2016 to October 2020 were retrospectively analyzed, including 11 males and 11 females, and they were 28-79 (56.4±13.5) years old. When the ICP monitoring probe was put in, before decompressive craniectomy and after the cerebrospinal fluid was released, and when the surgery was over, the ICP's were measured, and recorded as ICP1, ICP2, and ICP3. The difference between ICP2 and ICP3 was recorded as ΔICP. After the surgery, the ICP was continuously and dynamically monitored, and the ICP change and its relation with prognosis were analyzed. Independent-sample t test, paired t test, and Pearson correlation analysis were applied. Results　The ICP1, ICP2, ICP3, and peak ICP were (22.3±4.3), (20.3±3.9), (15.7±3.8) and (19.4±5.2) mmHg (1 mmHg=0.133 kPa), with a statistical difference between ICP2 and ICP3 (P<0.01), and the ΔICP was (4.6±1.9) mmHg. The craniectomy area was (22.5±1.6) cm², and the ΔICP had no correlation with it (P=0.17). By the end of the follow-up period, 18 patients survived, and 4 patients died. The score of Glasgow Outcome Scale (GOS) in the patients who survived was (3.9±1.5), and 16 patients had high survival quality, and their scores of GOS ≥ 4. The peak ICP and cumulative time for postoperative ICP to exceed the threshold (CTET) had impact on the patients' prognosis (r=0.31, P<0.01). Conclusion　ICP monitoring is valuable for SDC in the treatment of space-occupying cerebellar infarction and may predict the patients' prognosis.

Key words: Cerebellar infarction, Decompressive craniectomy, Intracranial pressure monitoring, Craniectomy area

摘要： 目的　探讨动态颅内压监测在占位性小脑梗死枕下后颅窝减压手术中的应用，分析颅内压变化规律及其对预后的影响。方法　回顾性分析了2016年10月至2020年10月，菏泽市立医院22例动态颅内压监测联合枕下后颅窝减压术治疗的占位性小脑梗死患者，其中男11例，女11例，年龄28～79（56.4±13.5）岁。手术时分别在颅内压监测探头置入时、释放脑脊液后去骨瓣减压前以及手术结束时3个时间点给予颅内压（ICP）测量并记录为ICP1、ICP2、ICP3，ICP2与ICP3的差值记录为ΔICP，术后持续动态监测颅内压，并分析颅内压的变化规律以及与预后的关系。统计学方法采用独立样本t检验、配对t检验、Pearson相关分析。结果　ICP1为（22.3±4.3）mmHg（1 mmHg=0.133 kPa），ICP2为（20.3±3.9）mmHg，ICP3为（15.7±3.8）mmHg，术后ICP峰值为（19.4±5.2）mmHg，ICP2与ICP3比较差异有统计学意义（P<0.01），二者差值ΔICP为（4.6±1.9）mmHg。减压骨窗面积为（22.5±1.6）cm²，ΔICP与其无相关性（P=0.17）。至随访结束时生存18例，死亡4例，生存患者格拉斯哥预后量表（GOS）评分为（3.9±1.5）分，其中16例为高质量生存质量（GOS≥4分）。颅内压峰值、颅内压超阈值累计时间与预后相关（r=0.31，P<0.01）。结论　颅内压监测肯定了手术治疗占位性小脑梗死的价值，其监测数值对病情的预后可提供一定的预测价值。

关键词: 小脑梗死, 去骨瓣减压, 颅内压监测, 骨窗面积

Zhao Duanyun, Zhang Haibing, Li Guanghong, Wang Hongbo. Application of dynamic intracranial pressure monitoring in suboccipital decompressive craniectomy for space-occupying cerebellar infarction[J]. International Medicine and Health Guidance News, 2022, 28(9): 1283-1287.

赵端允, 张海兵, 李光宏, 王洪波.

动态颅内压监测在占位性小脑梗死枕下后颅窝减压术中的应用 [J]. 国际医药卫生导报, 2022, 28(9): 1283-1287.

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Application of dynamic intracranial pressure monitoring in suboccipital decompressive craniectomy for space-occupying cerebellar infarction

动态颅内压监测在占位性小脑梗死枕下后颅窝减压术中的应用

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