• Ronald Benveniste, Iahn Cajigas, Jonathan Jagid, and Eva Wu.
• Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: rbenveniste@med.miami.edu.
• World Neurosurg. 2022 Jan 1; 157: e351-e356.

BackgroundPrimary decompressive craniectomy (DC) is commonly performed for patients with traumatic brain injury (TBI). Some, but not all patients, will benefit from invasive monitoring of intracranial pressure (ICP) after surgery. We intended to identify risk factors for elevated ICP after primary DC to treat TBI.MethodsA retrospective chart review study identified all patients at our institution who underwent primary DC for TBI during the study period and who had ICP monitors placed at the time of surgery. Various preoperative and intraoperative variables were assessed for correlation with the presence of postoperative elevated ICP.ResultsPostoperative elevated ICP occurred in 36% of patients after DC. In univariate analysis, Glasgow Coma Scale <8, abnormal pupillary examination, and intraoperative brain swelling were all associated with elevated postoperative ICP. However, in multivariate analysis only intraoperative brain swelling was associated with elevated postoperative ICP (incidence 56% vs. 5%, P = 0.0043).ConclusionsPlacement of an ICP monitor at the time of primary DC for patients with TBI should be considered if there is intraoperative brain swelling.Copyright © 2021 Elsevier Inc. All rights reserved.

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