• World Neurosurg · Dec 2021

    Multicenter Study Observational Study

    INTRACRANIAL PRESSURE MONITORING IN POOR-GRADE PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE TREATED BY COILING.

    • Roberto Imberti, Edoardo Picetti, Sandra Rossi, Emanuele Capaccio, Giovanni Accetta, Catherine Klersy, Elvis Lafe, Luigi Pietrobono, Francesco Cimino, Lara Frattini, Elena Grappa, Sergio Casagli, Emanuela Crobeddu, and Giorgio Antonio Iotti.
    • Phase I Clinical Trials Unit and Experimental Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: r.imbertipsm@gmail.com.
    • World Neurosurg. 2021 Dec 1; 156: e206-e214.

    ObjectiveThe main objective of the present study was to analyze the intracranial pressure (ICP) and cerebral perfusion pressure (CPP) changes during coiling. We also evaluated the prevalence of rebleeding and outcomes for patients monitored before and after coiling.MethodsNinety-nine consecutive poor-grade patients with aneurysmal subarachnoid hemorrhage (aSAH; World Federation of Neurological Surgeons grade IV and V) were enrolled in our prospective observational study. For 31 patients, ICP and CPP monitoring was started immediately after the diagnosis of aSAH, and the values were recorded every 15 minutes during coiling (early ICP group). For 68 patients, ICP and CPP monitoring began after coiling (late ICP group). The outcomes were evaluated at 90 days using the modified Rankin scale.ResultsAt the beginning of coiling, the ICP was >20 mm Hg in 10 patients (35.7%). The median ICP was 18 mm Hg (range, 5-60 mm Hg). The CPP was <60 mm Hg in 6 patients (24%). The median CPP was 70 mm Hg (range, 30-101 mm Hg). Despite medical treatment and/or cerebrospinal fluid drainage, 51.6% of the patients monitored during coiling had at least one episode of intracranial hypertension (defined as ICP >20 mm Hg), and 51.6% had at least one episode of reduced CPP (defined as CPP <60 mm Hg). Early monitoring (before aneurysm repair) was not associated with rebleeding. At 90 days, the functional recovery was better in the early ICP group (P = 0.004).ConclusionsDuring coiling, patients with poor-grade aSAH can experience episodes of intracranial hypertension and reduced CPP. Early and appropriate treatment of elevated ICP was not associated with rebleeding and might have improved the outcomes.Copyright © 2021 Elsevier Inc. All rights reserved.

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