Postoperative Development of Intracranial Hypertension in Cases with Craniocerebral Trauma: Risk Factors

Puras Yu.V., Talipov A.E.

Sklifosovsky Research Institute of Emergency Care, Moscow, Russia

 

Intracranial hypertension (IH) is a secondary injurious factor, having a considerable effect on a course and outcome of craniocerebral trauma (CCT).

The study goal has been determining risk factors of postoperative development of IH in cases with severe CCT.

Material and Methods. There were 70 cases with CCT, operated in 2003-2008. Monitoring of intracranial pressure (ICP) was carried out intraoperatively and in an immediate postoperative period. Data, obtained during clinical and instrumental examination, as well as results of ICP monitoring were analyzed with applying statistical methods.

Results. There were three types of ICP dynamics: a normotensive course (1), gradual development of intracranial hypertension (2) and acute development of intracranial hypertension (3). Cases with hematoma relapses were characterized by the second type of ICP dynamics. One could watch the first and third types of ICP dynamics in augmentation of brain edema or evolution of contusion foci. There was reliable correlation between ICP dynamics and an outcome of surgical treatment (p<0.05). Mortality in the first, second and third types if ICP dynamics was 39.1%, 76.9% and 81.8%, respectively. We managed to reveal reliable clinical and instrumental sighs (p<0.05), which allowed to prognosticate IH development in a postoperative period. They included an initial level of ICP of 30 mm Hg, dislocation syndrome at the level of midbrain and pons, CT- or MR-signs of brain stem ischemia, presence of subarachnoid hemorrhage according to data of CT-examination, gross deformity of basal cisterns.

Conclusion. IH, watched in a postoperative period, reliably worsens outcomes of surgical treatment. The above risk factors allow to prognosticate IH development in cases with severe CCT.