V.V. Krylov, A.E. Talypov, Yu.V. Puras
(Research Institute of Emergency Care, Faculty of Neurosurgery of the Moscow State Medical-Stomatologic University, Moscow)
Increase of intracranial pressure (ICP) is one of the pathogenetic factors, conditioning a course and outcome of severe craniocerebral trauma (CCT).
The Study Goal: To study ICP dynamics in casualties, who underwent surgical and conservative treatment for severe CCT and to identify risk factors, causing ICP increase.
Materials and Methods. The results of clinical and instrumental examinations, surgical and conservative treatment of 38 cases with CCT were analyzed. It was done with taking into account data of ICP monitoring during surgical intervention and in an early postoperative period. Osteoplastic trephination of the skull and decompression craniotomy were performed in 11 and 17 cases, respectively. Intensive care with control of ICP levels was carried out in 10 patients.
Correlation of the ICP initial level with clinical signs and results of CT-examination of the brain, effecting a course and outcome of severe CCT, was determined. The following factors were analyzed: age, consciousness impairment according to the Glasgow Coma Scale (GCS), pupillary reactions, disorders of muscular tonus, a stage of dislocation syndrome, a general view and volume of an injury focus, a value of lateral dislocation, a degree of axial dislocation, a value of the 2nd ventriculo-cranial ratio (VCR-2), estimated on the basis of CT findings.
Outcomes. Postoperative mortality was 61%. Satisfactory and good outcomes were watched in 29% and 10% of cases, respectively. There was no reliable correlation between initial levels of ICP and outcomes of surgical treatment.
Conclusions. Signs, indicative of development of marked intracranial hypertension (more than 40 mm Hg) in cases with severe CCT, included the score of consciousness impairment of less than 5 (GCS), anisocoria, reduced muscular tonus, an injury focus of more than 100 cm3, lateral dislocation of more than 15 mm, gross deformity of basal cisterns,VCR-2 of less than 9% according to CT findings. As for other clinical and CT signs, a value of ICP was characterized by considerable variability.