Bilateral Decompressive Hemicraniectomy for Diffuse Cerebral Edema and Medically Refractory Elevated Intracranial Pressure in Aneurysmal Subarachnoid Hemorrhage: A Case Series.
aneurysmal subarachnoid hemorrhage
anuerysm
cerebral edema
decompressive hemicraniectomy
elevated intracranial pressure
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
accepted:
16
09
2021
entrez:
21
10
2021
pubmed:
22
10
2021
medline:
22
10
2021
Statut:
epublish
Résumé
Decompressive hemicraniectomy (DCHC) may be indicated in the setting of subarachnoid hemorrhage (SAH) complicated by persistent elevated intracranial pressure (ICP) that is refractory to medical interventions. Outcomes can be variable as indications for surgery can include focal hematomas, infarctions, and regional or diffuse edema. Bilateral DCHC for medically refractory elevated ICP in the setting of SAH is not well described in the literature, and the viability of this option in terms of patient outcomes is unclear. We describe the cases of four patients with medically refractory ICP secondary to diffuse cerebral edema who underwent bilateral DCHC in the setting of SAH. This is a retrospective case review of four patients with aneurysmal SAH who underwent bilateral DCHC for management of diffuse global edema resulting in medically refractory ICP. We describe two patients who made impressive recoveries after bilateral DCHC and two patients who required significant continued care needs despite ICP control in all patients. Bilateral DCHC is a viable option for control of refractory elevated ICP in SAH patients who develop diffuse cerebral edema. Bilateral DCHC in this setting can be considered after exhaustion of other therapeutic options.
Identifiants
pubmed: 34671533
doi: 10.7759/cureus.18057
pmc: PMC8520698
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e18057Informations de copyright
Copyright © 2021, Quig et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Cerebrovasc Dis. 2008;26(6):612-7
pubmed: 18946217
World Neurosurg. 2010 Oct-Nov;74(4-5):465-71
pubmed: 21492596
Neurosurgery. 2005;56(1):12-9; dicussion 19-20
pubmed: 15617581
Stroke. 2007 Sep;38(9):2518-25
pubmed: 17690310
Neurosurg Focus. 2009 Jun;26(6):E4
pubmed: 19485717
Stroke. 2007 Mar;38(3):987-92
pubmed: 17272765
N Engl J Med. 2016 Sep 22;375(12):1119-30
pubmed: 27602507
Lancet. 2017 Feb 11;389(10069):655-666
pubmed: 27637674
Br J Neurosurg. 2018 Apr;32(2):149-156
pubmed: 29172712
Lancet Neurol. 2009 Apr;8(4):326-33
pubmed: 19269254
J Neurosurg. 2015 Sep;123(3):609-17
pubmed: 26115467