Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study
BackgroundDecompressive craniectomy (DC) improves the survival and functional outcomes in patients with malignant cerebral infarction. Currently, there are no objective intraoperative markers that indicates adequate decompression. We hypothesise that closure intracranial pressure (ICP) correlates wi...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-05-01
|
| Series: | Frontiers in Surgery |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.823899/full |
| _version_ | 1818268916763328512 |
|---|---|
| author | Jia Xu Lim Sherry Jiani Liu Tien Meng Cheong Seyed Ehsan Saffari Julian Xinguang Han Min Wei Chen |
| author_facet | Jia Xu Lim Sherry Jiani Liu Tien Meng Cheong Seyed Ehsan Saffari Julian Xinguang Han Min Wei Chen |
| author_sort | Jia Xu Lim |
| collection | DOAJ |
| description | BackgroundDecompressive craniectomy (DC) improves the survival and functional outcomes in patients with malignant cerebral infarction. Currently, there are no objective intraoperative markers that indicates adequate decompression. We hypothesise that closure intracranial pressure (ICP) correlates with postoperative outcomes.MethodsThis is a multicentre retrospective review of all 75 DCs performed for malignant cerebral infarction. The patients were divided into inadequate ICP (iICP) and good ICP (gICP) groups based on a suitable ICP threshold determined with tiered receiver operating characteristic and association analysis. Multivariable logistic regression was performed for various postoperative outcomes.ResultsAn ICP threshold of 7 mmHg was determined, with 36 patients (48.0%) and 39 patients (52.0%) in the iICP and gICP group, respectively. After adjustment, postoperative osmotherapy usage was more likely in the iICP group (OR 6.32, p = 0.003), and when given, was given for a longer median duration (iICP, 4 days; gICP, 1 day, p = 0.003). There was no difference in complications amongst both groups. When an ICP threshold of 11 mmHg was applied, there was significant difference in the duration on ventilator (ICP ≥11 mmHg, 3–9 days, ICP <11 mmHg, 3–5 days, p = 0.023).ConclusionSurgical decompression works complementarily with postoperative medical therapy to manage progressive cerebral edema in malignant cerebral infarctions. This is a retrospective study which showed that closure ICP, a novel objective intraoperative biomarker, is able to guide the adequacy of DC in this condition. Various surgical manoeuvres can be performed to ensure that this surgical aim is accomplished. |
| first_indexed | 2024-12-12T20:46:06Z |
| format | Article |
| id | doaj.art-8317b1ac656c4aa6b83c41af96619bf5 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-12T20:46:06Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-8317b1ac656c4aa6b83c41af96619bf52022-12-22T00:12:34ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-05-01910.3389/fsurg.2022.823899823899Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational StudyJia Xu Lim0Sherry Jiani Liu1Tien Meng Cheong2Seyed Ehsan Saffari3Julian Xinguang Han4Min Wei Chen5National Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, SingaporeNational Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, SingaporeNational Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, SingaporeCenter for Qualitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore, SingaporeNational Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, SingaporeNational Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, SingaporeBackgroundDecompressive craniectomy (DC) improves the survival and functional outcomes in patients with malignant cerebral infarction. Currently, there are no objective intraoperative markers that indicates adequate decompression. We hypothesise that closure intracranial pressure (ICP) correlates with postoperative outcomes.MethodsThis is a multicentre retrospective review of all 75 DCs performed for malignant cerebral infarction. The patients were divided into inadequate ICP (iICP) and good ICP (gICP) groups based on a suitable ICP threshold determined with tiered receiver operating characteristic and association analysis. Multivariable logistic regression was performed for various postoperative outcomes.ResultsAn ICP threshold of 7 mmHg was determined, with 36 patients (48.0%) and 39 patients (52.0%) in the iICP and gICP group, respectively. After adjustment, postoperative osmotherapy usage was more likely in the iICP group (OR 6.32, p = 0.003), and when given, was given for a longer median duration (iICP, 4 days; gICP, 1 day, p = 0.003). There was no difference in complications amongst both groups. When an ICP threshold of 11 mmHg was applied, there was significant difference in the duration on ventilator (ICP ≥11 mmHg, 3–9 days, ICP <11 mmHg, 3–5 days, p = 0.023).ConclusionSurgical decompression works complementarily with postoperative medical therapy to manage progressive cerebral edema in malignant cerebral infarctions. This is a retrospective study which showed that closure ICP, a novel objective intraoperative biomarker, is able to guide the adequacy of DC in this condition. Various surgical manoeuvres can be performed to ensure that this surgical aim is accomplished.https://www.frontiersin.org/articles/10.3389/fsurg.2022.823899/fulllarge territory infarctionsdecompressive craniectomyintracranial pressuremodified Rankin scaleoutcomesmiddle cerebral artery infarction |
| spellingShingle | Jia Xu Lim Sherry Jiani Liu Tien Meng Cheong Seyed Ehsan Saffari Julian Xinguang Han Min Wei Chen Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study Frontiers in Surgery large territory infarctions decompressive craniectomy intracranial pressure modified Rankin scale outcomes middle cerebral artery infarction |
| title | Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study |
| title_full | Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study |
| title_fullStr | Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study |
| title_full_unstemmed | Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study |
| title_short | Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study |
| title_sort | intracranial pressure as an objective biomarker of decompression adequacy in large territory infarction a multicenter observational study |
| topic | large territory infarctions decompressive craniectomy intracranial pressure modified Rankin scale outcomes middle cerebral artery infarction |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.823899/full |
| work_keys_str_mv | AT jiaxulim intracranialpressureasanobjectivebiomarkerofdecompressionadequacyinlargeterritoryinfarctionamulticenterobservationalstudy AT sherryjianiliu intracranialpressureasanobjectivebiomarkerofdecompressionadequacyinlargeterritoryinfarctionamulticenterobservationalstudy AT tienmengcheong intracranialpressureasanobjectivebiomarkerofdecompressionadequacyinlargeterritoryinfarctionamulticenterobservationalstudy AT seyedehsansaffari intracranialpressureasanobjectivebiomarkerofdecompressionadequacyinlargeterritoryinfarctionamulticenterobservationalstudy AT julianxinguanghan intracranialpressureasanobjectivebiomarkerofdecompressionadequacyinlargeterritoryinfarctionamulticenterobservationalstudy AT minweichen intracranialpressureasanobjectivebiomarkerofdecompressionadequacyinlargeterritoryinfarctionamulticenterobservationalstudy |