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Refractory ICP

Lelio Guida, Fabio Mazzoleni, Alberto Bozzetti, Erik Sganzerla, Carlo Giussani
We present a case of almost complete bifrontal dural ossification after decompressive craniectomy for severe traumatic brain injury. A 6 years old boy was brought to the Emergency Room after a severe traumatic brain injury (GCS 7). Due to rapidly increasing ICP values (>20 mmHg) refractory to conservative therapy and in absence of focal lesions justifying the neurological status, a bicoronal decompressive craniectomy was performed. 110 days after surgery patient underwent reconstructive bifrontal cranioplasty with autologous bone...
August 24, 2018: World Neurosurgery
Sarang Koushik, Narjeet Khurmi, Richard Helmers
No abstract text is available yet for this article.
April 2018: Journal of Anaesthesiology, Clinical Pharmacology
Patrick Reid, Irene Say, Smit Shah, Sneha Tolia, Shashank Musku, Charles Prestigiacomo, Chirag D Gandhi
BACKGROUND: Decompressive hemicraniectomy to control medically refractory intracranial hypertension and cerebral edema and evacuate mass lesions in traumatic brain injury is a widely accepted treatment paradigm. However, the critical specifications of the bone flap size necessary to control the intracranial pressure (ICP) and provide improved patient outcomes is unknown. We assessed the effect of craniectomy size on the outcomes in surgical decompression for traumatic brain injury. METHODS: From 2003 to 2011, 58 cases of decompressive hemicraniectomy were performed for evacuation of hematoma and treatment of refractory ICP in adult patients with traumatic brain injury...
November 2018: World Neurosurgery
Michel Roethlisberger, Lara Gut, Daniel Walter Zumofen, Urs Fisch, Oliver Boss, Nicolai Maldaner, Davide Marco Croci, Ethan Taub, Natascia Corti, Jan-Karl Burkhardt, Raphael Guzman, Oliver Bozinov, Luigi Mariani
OBJECTIVE Women taking combined hormonal contraceptives (CHCs) are generally considered to be at low risk for cerebral venous thrombosis (CVT). When it does occur, however, intensive care and neurosurgical management may, in rare cases, be needed for the control of elevated intracranial pressure (ICP). The use of nonsurgical strategies such as barbiturate coma and induced hypothermia has never been reported in this context. The objective of this study is to determine predictive factors for invasive or surgical ICP treatment and the potential complications of nonsurgical strategies in this population...
July 2018: Neurosurgical Focus
Rathin Pujari, Peter J Hutchinson, Angelos G Kolias
Traumatic brain injury (TBI) remains a leading cause of mortality and disability worldwide. Surgical intervention is one of the main pillars of TBI management. The mainstay of treatment for substantial intracranial hematomas is surgical evacuation. In addition, patients with TBI may have brain swelling and increased intracranial pressure. If the latter is refractory to medical management, surgical interventions can be helpful. In this review we seek to outline the major tenets of the surgical management of TBI...
October 2018: Journal of Neurosurgical Sciences
Jiajie Gu, Haoping Huang, Yuejun Huang, Haitao Sun, Hongwu Xu
Hyperosmolar therapy is regarded as the mainstay for treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI). This still has been disputed as application of hypertonic saline (HS) or mannitol for treating patients with severe TBI. Thus, this meta-analysis was performed to further compare the advantages and disadvantages of mannitol with HS for treating elevated ICP after TBI. We conducted a systematic search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Wan Fang Data, VIP Data, SinoMed, and China National Knowledge Infrastructure (CNKI) databases...
June 15, 2018: Neurosurgical Review
Sivashakthi Kanagalingam, Prem S Subramanian
PURPOSE OF REVIEW: This review presents a critical appraisal of current therapeutic strategies for patients with idiopathic intracranial hypertension (IIH). We present the reader with the most recent evidence to support medical and surgical interventions in patients with IIH and provide recommendations about treatment initiation and escalation. We also indicate areas where knowledge gaps exist regarding therapeutic efficacy and superiority of one intervention over another. RECENT FINDINGS: A double-masked, randomized prospective study of medical management of patients with mild IIH (Idiopathic Intracranial Hypertension Treatment Trial-IIHTT) has established that acetazolamide therapy has additional efficacy when compared to weight loss alone...
May 28, 2018: Current Treatment Options in Neurology
Jussiane Souza Silva, Alessandra Schneider Henn, Valderi Luiz Dressler, Paola Azevedo Mello, Erico Marlon Moraes Flores
A comprehensive study was developed showing the feasibility of determination of rare earth elements (REE) in low concentration in crude oil by using direct sampling electrothermal vaporization system coupled to inductively coupled plasma mass spectrometry (ETV-ICP-MS). The effect of organic modifier on the REE signal was evaluated and the use of 6 mg of citric acid allowed calibration using aqueous reference solutions (selected pyrolysis and vaporization temperatures were 700 and 2200 °C, respectively). Because of the facility of REE in forming refractory compounds inside the graphite furnace during the heating step, the use of a modifier gas (Freon R-12, 3...
June 5, 2018: Analytical Chemistry
Tara L Sacco, Samantha A Delibert
Dangerous, sustained elevation in intracranial pressure (ICP) is a risk for any patient following severe brain injury. Intracranial pressure elevations that do not respond to initial management are considered refractory to treatment, or rICP. Patients are at significant risk of secondary brain injury and permanent loss of function resulting from rICP. Both nonpharmacologic and pharmacologic interventions are utilized to intervene when a patient experiences either elevation in ICP or rICP. In part 1 of this 2-part series, pharmacologic interventions are discussed...
May 2018: Dimensions of Critical Care Nursing: DCCN
Casey J Allen, Daniel J Baldor, Mena M Hanna, Nicholas Namias, M Ross Bullock, Jonathan R Jagid, Kenneth G Proctor
After traumatic brain injury, decompressive craniectomy (DC) is a second-tier, late therapy for refractory intracranial hypertension. We hypothesize that early DC, based on CT evidence of intracranial hypertension, improves intracranial pressure (ICP) and cerebral perfusion pressure (CPP). From September 2008 to January 2015, 286 traumatic brain injury patients requiring invasive ICP monitoring at a single Level I trauma center were reviewed. DC and non-DC patients were propensity score matched 1:1, based on demographics, hemodynamics, injury severity score (ISS), Glasgow Coma Scale (GCS), transfusion requirements, and need for vasopressor therapy...
March 1, 2018: American Surgeon
Matheus Fernando Manzolli Ballestero, Thiago Lyrio Teixeira, Lucas Pires Augusto, Stephanie Naomi Funo de Souza, Marcelo Volpon Santos, Ricardo Santos de Oliveira
BACKGROUND: Primary idiopathic intracranial hypertension (PIIH) in children is rare and has a poorly understood pathophysiology. It is characterized by raised intracranial pressure (ICP) in the absence of an identified brain lesion. Diagnosis is usually confirmed by the measurement of a high cerebrospinal fluid (CSF) opening pressure and exclusion of secondary causes of intracranial hypertension. Refractory PIIH may lead to severe visual impairment. The purpose of this study was to evaluate a cranial morcellation decompression (CMD) technique as a new surgical alternative to stabilize intracranial pressure in PIIH...
June 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Adam John Covach, William Nicholas Rose
Objectives  We report on a patient suffering from intractable itching secondary to intrahepatic cholestasis of pregnancy (ICP) unresponsive to conventional medical therapies. She was started on a regimen of therapeutic plasma exchange (TPE), which is often efficacious in relieving patient's itching from all causes of cholestasis, including ICP. Methods  We performed a retrospective review of a patient's medical record. Results  Following initial TPE, the patient reported dramatic relief of her itching and consequent insomnia...
October 2017: American Journal of Perinatology Reports
Marlies Bauer, Florian Sohm, Claudius Thomé, Martin Ortler
Background: Cerebrospinal fluid (CSF) drainage via ventricular puncture is an established therapy of elevated intracranial pressure (ICP). In contrast, lumbar CSF removal is believed to be contraindicated with intracranial hypertension. Methods: We investigated the safety and efficacy of lumbar CSF drainage to decrease refractory elevated ICP in a small cohort of patients with traumatic brain injury (TBI). A score (0-8 points) was used to assess computed tomography (CT) images for signs of herniation and for patency of the basal cisterns...
2017: Surgical Neurology International
John K Yue, Jonathan W Rick, Hansen Deng, Michael J Feldman, Ethan A Winkler
Traumatic brain injury (TBI) is a common cause of permanent disability for which clinical management remains suboptimal. Elevated intracranial pressure (ICP) is a common sequela following TBI leading to death and permanent disability if not properly managed. While clinicians often employ stepwise acute care algorithms to reduce ICP, a number of patients will fail medical management and may be considered for surgical decompression. Decompressive craniectomy (DC) involves removing a component of the bony skull to allow cerebral tissue expansion in order to reduce ICP...
November 7, 2017: Journal of Neurosurgical Sciences
Lorenzo Giammattei, Mahmoud Messerer, Mauro Oddo, Francois Borsotti, Marc Levivier, Roy T Daniel
BACKGROUND: The current surgical treatment of choice for refractory intracranial hypertension after traumatic brain injury (TBI) is decompressive craniectomy. Despite efficacy in control of intracranial pressure (ICP), its contribution to an improved outcome is debatable. CASE DESCRIPTION: We describe a case of refractory intracranial hypertension successfully managed with cisternostomy. The rationale for this surgical technique is discussed, with a focus on the pathophysiologic processes underlying elevated ICP and its improvement after surgery...
January 2018: World Neurosurgery
Daniel Agustín Godoy, Walter Videtta, Mario Di Napoli
Intracranial hypertension is one of leading causes of mortality after acute brain injury. Its causes and origins are multiple. The approach should be based on the underlying pathophysiology. There are different therapeutic modalities to control increased intracranial pressure (ICP), but all share the objective of normalizing basic physiologic variables. ICP control should be combined with adequate cerebral perfusion pressure. The classic approach to ICP control is unidirectional and sequential escalation of therapy...
November 2017: Neurologic Clinics
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
December 2017: Anesthesia and Analgesia
Daniel Agustín Godoy, Pablo David Guerrero Suarez, Luis Rafael Moscote-Salazar, Mario Di Napoli
Intracranial hypertension (IH) is one of the final pathways of acute brain injury. In severe traumatic brain injury (sTBI), it independently predicts poor outcomes. Its control represents a key aspect of the management. Lack of response to conventional therapies signals a state of ''refractory IH'', with an associated mortality rate of 80-100%. In such cases, hypothermia, barbiturates at high doses (BBT), decompressive craniectomy (DC), and extreme hyperventilation are utilized. However, none of them has proven efficacy...
July 2017: Bulletin of Emergency and Trauma
Adriano Barreto Nogueira, Eva Annen, Oliver Boss, Faraneh Farokhzad, Christopher Sikorski, Emanuela Keller
BACKGROUND: To assess whether circadian patterns of temperature correlate with further values of intracranial pressure (ICP) in severe brain injury treated with hypothermia. METHODS: We retrospectively analyzed temperature values in subarachnoid hemorrhage patients treated with hypothermia by endovascular cooling. The circadian patterns of temperature were correlated with the mean ICP across the following day (ICP24 ). RESULTS: We analyzed data from 17 days of monitoring of three subarachnoid hemorrhage patients that underwent aneurysm coiling, sedation and hypothermia due to refractory intracranial hypertension and/or cerebral vasospasm...
August 3, 2017: Journal of Translational Medicine
Santiago T Lubillo, Dácil M Parrilla, José Blanco, Jesús Morera, Jaime Dominguez, Felipe Belmonte, Patricia López, Ismael Molina, Candelaria Ruiz, Francisco J Clemente, Daniel A Godoy
OBJECTIVE In severe traumatic brain injury (TBI), the effects of decompressive craniectomy (DC) on brain tissue oxygen pressure (PbtO2 ) and outcome are unclear. The authors aimed to investigate whether changes in PbtO2 after DC could be used as an independent prognostic factor. METHODS The authors conducted a retrospective, observational study at 2 university hospital ICUs. The study included 42 patients who were admitted with isolated moderate or severe TBI and underwent intracranial pressure (ICP) and PbtO2 monitoring before and after DC...
May 2018: Journal of Neurosurgery
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