Spinalis liquorlebocsátással szerzett kezdeti tapasztalatok koponyasérülést követo befolyásolhatatlan intracranialis nyomásfokozódás kezelésében

Translated title of the contribution: Preliminary experience with controlled lumbar drainage in medically refractory intracranial hypertension

Adrienn Tömösvári, Zoltán Mencser, Judit Futó, Anna Hortobágyi, Mihály Bodosi, P. Barzó

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: The contribution of brain edema to brain swelling in cases of traumatic brain injury remains a critical problem. In head injury, the swelling and eventual rise in intracranial pressure is a frequent cause of death, and in survivors the poor prognosis with sustained elevation of ICP has been well documented. Objective: The objective this study was to evaluate the effect of controlled lumbar cerebrospinal fluid drainage in adult patients with refractory intracranial hypertension following severe brain injury. Method: The study involved 10 head injured patients (GCS ≤ 8) with medically refractory intracranial hypertension. Aggressive treatment included the repeated steps of the Brain Trauma Foundation's guidelines, barbiturate coma and in many cases decompressive craniectomy as well. After institution of a lumbar drain, cerebrospinal fluid drainage was maintained under control of intracranial pressure (ICP) and neurological status. ICP and cerebral perfusion pressure before and after initiation of lumbar cerebrospinal fluid drainage and related complications were documented. Results: All patients demonstrated an immediate decrease of ICP (from 30.6 ± 4.7 mm Hg to 11.5 ± 3.9 mm Hg, mean ± SD) and a concomitant increase of cerebral perfusion pressure. In seven patients the decrease of ICP was long lasting and 5 of them had a favourable outcome. Two patients survived with a severe permanent neurologic deficit and only three patients died because of the progressive brain edema, which developed despite of the maximum therapy. Conclusion: In conclusion we may consider, that controlled lumbar cerebrospinal fluid drainage is a potentially useful treatment in cases of severe traumatic brain injury when maximal medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high intracranial hypertension. The danger of herniation is minimized by considering lumbar drainage in the presence of discernible basilar cisterns only.

Original languageHungarian
Pages (from-to)159-164
Number of pages6
JournalOrvosi Hetilap
Volume146
Issue number4
Publication statusPublished - 2005

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Intracranial Hypertension
Intracranial Pressure
Drainage
Cerebrovascular Circulation
Brain Edema
Decompressive Craniectomy
Therapeutics
Coma
Neurologic Manifestations
Craniocerebral Trauma
Brain Injuries
Survivors
Cerebrospinal Fluid
Cause of Death
Head
Guidelines
Cerebrospinal Fluid Leak
Traumatic Brain Injury

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Spinalis liquorlebocsátással szerzett kezdeti tapasztalatok koponyasérülést követo befolyásolhatatlan intracranialis nyomásfokozódás kezelésében. / Tömösvári, Adrienn; Mencser, Zoltán; Futó, Judit; Hortobágyi, Anna; Bodosi, Mihály; Barzó, P.

In: Orvosi Hetilap, Vol. 146, No. 4, 2005, p. 159-164.

Research output: Contribution to journalArticle

Tömösvári, Adrienn ; Mencser, Zoltán ; Futó, Judit ; Hortobágyi, Anna ; Bodosi, Mihály ; Barzó, P. / Spinalis liquorlebocsátással szerzett kezdeti tapasztalatok koponyasérülést követo befolyásolhatatlan intracranialis nyomásfokozódás kezelésében. In: Orvosi Hetilap. 2005 ; Vol. 146, No. 4. pp. 159-164.
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T1 - Spinalis liquorlebocsátással szerzett kezdeti tapasztalatok koponyasérülést követo befolyásolhatatlan intracranialis nyomásfokozódás kezelésében

AU - Tömösvári, Adrienn

AU - Mencser, Zoltán

AU - Futó, Judit

AU - Hortobágyi, Anna

AU - Bodosi, Mihály

AU - Barzó, P.

PY - 2005

Y1 - 2005

N2 - Introduction: The contribution of brain edema to brain swelling in cases of traumatic brain injury remains a critical problem. In head injury, the swelling and eventual rise in intracranial pressure is a frequent cause of death, and in survivors the poor prognosis with sustained elevation of ICP has been well documented. Objective: The objective this study was to evaluate the effect of controlled lumbar cerebrospinal fluid drainage in adult patients with refractory intracranial hypertension following severe brain injury. Method: The study involved 10 head injured patients (GCS ≤ 8) with medically refractory intracranial hypertension. Aggressive treatment included the repeated steps of the Brain Trauma Foundation's guidelines, barbiturate coma and in many cases decompressive craniectomy as well. After institution of a lumbar drain, cerebrospinal fluid drainage was maintained under control of intracranial pressure (ICP) and neurological status. ICP and cerebral perfusion pressure before and after initiation of lumbar cerebrospinal fluid drainage and related complications were documented. Results: All patients demonstrated an immediate decrease of ICP (from 30.6 ± 4.7 mm Hg to 11.5 ± 3.9 mm Hg, mean ± SD) and a concomitant increase of cerebral perfusion pressure. In seven patients the decrease of ICP was long lasting and 5 of them had a favourable outcome. Two patients survived with a severe permanent neurologic deficit and only three patients died because of the progressive brain edema, which developed despite of the maximum therapy. Conclusion: In conclusion we may consider, that controlled lumbar cerebrospinal fluid drainage is a potentially useful treatment in cases of severe traumatic brain injury when maximal medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high intracranial hypertension. The danger of herniation is minimized by considering lumbar drainage in the presence of discernible basilar cisterns only.

AB - Introduction: The contribution of brain edema to brain swelling in cases of traumatic brain injury remains a critical problem. In head injury, the swelling and eventual rise in intracranial pressure is a frequent cause of death, and in survivors the poor prognosis with sustained elevation of ICP has been well documented. Objective: The objective this study was to evaluate the effect of controlled lumbar cerebrospinal fluid drainage in adult patients with refractory intracranial hypertension following severe brain injury. Method: The study involved 10 head injured patients (GCS ≤ 8) with medically refractory intracranial hypertension. Aggressive treatment included the repeated steps of the Brain Trauma Foundation's guidelines, barbiturate coma and in many cases decompressive craniectomy as well. After institution of a lumbar drain, cerebrospinal fluid drainage was maintained under control of intracranial pressure (ICP) and neurological status. ICP and cerebral perfusion pressure before and after initiation of lumbar cerebrospinal fluid drainage and related complications were documented. Results: All patients demonstrated an immediate decrease of ICP (from 30.6 ± 4.7 mm Hg to 11.5 ± 3.9 mm Hg, mean ± SD) and a concomitant increase of cerebral perfusion pressure. In seven patients the decrease of ICP was long lasting and 5 of them had a favourable outcome. Two patients survived with a severe permanent neurologic deficit and only three patients died because of the progressive brain edema, which developed despite of the maximum therapy. Conclusion: In conclusion we may consider, that controlled lumbar cerebrospinal fluid drainage is a potentially useful treatment in cases of severe traumatic brain injury when maximal medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high intracranial hypertension. The danger of herniation is minimized by considering lumbar drainage in the presence of discernible basilar cisterns only.

KW - Brain edema

KW - Intracranial pressure

KW - Lumbar drainage

KW - Traumatic brain injury

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JO - Orvosi Hetilap

JF - Orvosi Hetilap

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