• M Jaeger, M Soehle, and J Meixensberger.
• Department of Neurosurgery, University of Leipzig, Germany. jaem@medizin.uni-leipzig.de
• Acta Neurochir. Suppl. 2005 Jan 1;95:117-8.

BackgroundWe evaluated the perioperative and intraoperative changes of intracranial pressure (ICP) and partial pressure of brain tissue oxygen (PtiO2) after decompressive craniectomy in patients with diffuse brain oedema and space occupying infarction.MethodsTen patients suffering from medically intractable raised intracranial pressure (ICP) were included. The underlying diseases and causes for elevated ICP were diffuse brain oedema after subarachnoid haemorrhage (n = 3) and head injury (n = 3), or space occupying infarction of the middle cerebral artery territory due to vasospasm after SAH (n = 4). Continuous perioperative and intraoperative monitoring of PtiO2 and ICP was performed at the side of decompression.FindingsICP and PtiO2 improved significantly in a uniform pattern during bone flap removal and dura opening, irrespective of the underlying disease (mean ICP from 52 mmHg to 8 mmHg, mean PtiO2 from 9 mmHg to 25 mmHg). ICP, PtiO2, and cerebral perfusion pressure were further improved in the subsequent 12 hours after surgery, as compared to the preoperative 12 hours.ConclusionsDecompressive craniectomy seems to be a successful option in the treatment of intractable intracranial hypertension with associated cerebral hypoxia. These positive effects may last for several hours after the procedure irrespective of the underlying disease.

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