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- Title
The value of intraoperative intracranial pressure monitoring for predicting re-operation using salvage decompressive craniectomy after craniotomy in patients with traumatic mass lesions.
- Authors
He-xiang Zhao; Yi Liao; Ding Xu; Qiang-ping Wang; Qi Gan; Chao You; Chao-hua Yang; Zhao, He-xiang; Liao, Yi; Xu, Ding; Wang, Qiang-ping; Gan, Qi; You, Chao; Yang, Chao-hua
- Abstract
<bold>Background: </bold>The risk factors of predicting the need for postoperative decompressive craniectomy due to intracranial hypertension after primary craniotomy remain unclear. This study aimed to investigate the value of intraoperative intracranial pressure (ICP) monitoring in predicting re-operation using salvage decompressive craniectomy (SDC).<bold>Methods: </bold>From January 2008 to October 2014, we retrospectively reviewed 284 patients with severe traumatic brain injury (STBI) who underwent craniotomy for mass lesion evacuation without intraoperative brain swelling. Intraoperative ICP was documented at the time of initial craniotomy and then again after the dura was sutured. SDC was used when postoperative ICP was continually higher than 25 mmHg for 1 h without a downward trend. Univariate and multivariate analyses were applied to both initial demographic and radiographic features to identify risk factors of SDC requirement.<bold>Results: </bold>Of 284, 41 (14.4%) patients who underwent SDC had a higher Initial ICP than those who didn't (38.1 ± 9.2 vs. 29.3 ± 8.1 mmHg, P < 0.001), but there was no difference in ICP after the dura was sutured. The factors which have significant effects on SDC are higher initial ICP [odds ratio (OR): 1.100, 95% confidence interval (CI): 1.052-1.151, P < 0.001], older age (OR: 1.039, 95% CI: 1.002-1.077, P = 0.039), combined lesions (OR: 3.329, 95% CI: 1.199-9.244, P = 0.021) and early hypotension (OR: 2.524, 95% CI: 1.107-5.756, P = 0.028). The area under the curve of multivariate regression model was 0.771.<bold>Conclusions: </bold>The incidence of re-operation using SDC after craniotomy was 14.4%. The independent risk factors of SDC requirement are initial ICP, age, early hypotension and combined lesions.
- Subjects
CHINA; BRAIN injuries; PATIENTS; INTRACRANIAL pressure; INTRAOPERATIVE care; REOPERATION; SALVAGE therapy; DECOMPRESSIVE craniectomy; CRANIOTOMY; INTRACRANIAL hypertension; INTRAOPERATIVE monitoring; POSTOPERATIVE period; RETROSPECTIVE studies; DISEASE complications
- Publication
BMC Surgery, 2015, Vol 15, p1
- ISSN
1471-2482
- Publication type
journal article
- DOI
10.1186/s12893-015-0100-7