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BMC Surgery
Published in: BMC Surgery 1/2015

Open Access 01-12-2015 | Research article

The value of intraoperative intracranial pressure monitoring for predicting re-operation using salvage decompressive craniectomy after craniotomy in patients with traumatic mass lesions

Authors: He-xiang Zhao, Yi Liao, Ding Xu, Qiang-ping Wang, Qi Gan, Chao You, Chao-hua Yang

Published in: BMC Surgery | Issue 1/2015

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Abstract

Background

The risk factors of predicting the need for postoperative decompressive craniectomy due to intracranial hypertension after primary craniotomy remain unclear. This study aimed to investigate the value of intraoperative intracranial pressure (ICP) monitoring in predicting re-operation using salvage decompressive craniectomy (SDC).

Methods

From January 2008 to October 2014, we retrospectively reviewed 284 patients with severe traumatic brain injury (STBI) who underwent craniotomy for mass lesion evacuation without intraoperative brain swelling. Intraoperative ICP was documented at the time of initial craniotomy and then again after the dura was sutured. SDC was used when postoperative ICP was continually higher than 25 mmHg for 1 h without a downward trend. Univariate and multivariate analyses were applied to both initial demographic and radiographic features to identify risk factors of SDC requirement.

Results

Of 284, 41 (14.4 %) patients who underwent SDC had a higher Initial ICP than those who didn’t (38.1 ± 9.2 vs. 29.3 ± 8.1 mmHg, P < 0.001), but there was no difference in ICP after the dura was sutured. The factors which have significant effects on SDC are higher initial ICP [odds ratio (OR): 1.100, 95 % confidence interval (CI): 1.052–1.151, P < 0.001], older age (OR: 1.039, 95 % CI: 1.002–1.077, P = 0.039), combined lesions (OR: 3.329, 95 % CI: 1.199–9.244, P = 0.021) and early hypotension (OR: 2.524, 95 % CI: 1.107–5.756, P = 0.028). The area under the curve of multivariate regression model was 0.771.

Conclusions

The incidence of re-operation using SDC after craniotomy was 14.4 %. The independent risk factors of SDC requirement are initial ICP, age, early hypotension and combined lesions.
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Metadata
Title
The value of intraoperative intracranial pressure monitoring for predicting re-operation using salvage decompressive craniectomy after craniotomy in patients with traumatic mass lesions
Authors
He-xiang Zhao
Yi Liao
Ding Xu
Qiang-ping Wang
Qi Gan
Chao You
Chao-hua Yang
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2015
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-015-0100-7

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