V.V. Krylov, L.E. Talypov, Yu.V. Puras
(Sklifosovsky Research Institute of Emergency Care, Moscow)
Increase of intracranial pressure (ICP) is one of the pathogenetic mechanisms, determining a clinical course and outcome of craniocerebral trauma (CCT).
The study goal was estimating ICP dynamics in cases, subjected to surgical and conservative treatment for severe brain trauma, and determining risk factors, responsible for ICP increase.
Material and Methods. Results of surgical and conservative treatment of 38 cases with CCT were estimated with applying both clinical and instrumental methods. Data of ICP monitoring, carried out during surgical intervention and an immediate postoperative period, were taken into account.
Osteoplastic trephination and decompression craniotomy were performed in 11 and 17 cases respectively. Intensive care under conditions of ICP control was carried out in 10 patients.
Correlation between the initial level of ICP and clinical signs and CT findings, effecting a clinical course and outcome in severe CCT, was determined. We analyzed the following factors: age, consciousness depression according to the Glasgow Coma Scale (GCS), papillary reflexes, muscular tonicity disorders, a stage of dislocation syndrome, a type and volume of a lesion focus, a value of lateral dislocation, a degree of axial dislocation, the second ventriculocranial ratio (VCR-2), estimated on the basis of CT data.
Outcomes. Postoperative mortality was 61%. Satisfactory and good outcomes were watched in 29% and 10% of cases respectively. There was no reliable correlation between the initial level of ICP and results of surgical treatment.
Conclusions. Signs of marked intracranial hypertension development (more than 40 mm Hg) in cases with CCT were as follows: a level of consciousness depression, characterized by a score of less than 5 (GCS), anisocoria, reduced muscular tonicity, a lesion focus volume of more than 100 cm3, a lateral dislocation value of more than 15 cm, gross deformity of basal cisterns and VCR-2 of less than 9%.
The analysis of other clinical and CT signs was indicative of the ICP value variability.