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01.08.2011 | Practical Pearl

Multimodality Neuromonitoring and Decompressive Hemicraniectomy After Subarachnoid Hemorrhage

verfasst von: Robert Morgan Stuart, Jan Claassen, Michael Schmidt, Raimund Helbok, Pedro Kurtz, Luis Fernandez, Kiwon Lee, Neeraj Badjatia, Stephan A. Mayer, Sean Lavine, E. Sander Connolly

Erschienen in: Neurocritical Care | Ausgabe 1/2011

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Abstract

Background and Methods

We report the case of a young woman with delayed cerebral infarction and intracranial hypertension following subarachnoid hemorrhage requiring hemicraniectomy, who underwent multimodality neuromonitoring of the contralateral hemisphere before and after craniectomy.

Results

Intracranial hypertension was preceded by signs of ischemia and impaired brain metabolism diagnosed through cerebral microdialysis and PbtO2 monitoring, as well as a decrease in cerebral perfusion pressure (CPP) to <40 mmHg despite increasing vasopressor requirements. We describe how a comprehensive multimodality neuromonitoring approach was utilized to inform the decision to perform an early decompressive hemicraniectomy. Post-operatively, CPP and intracranial pressure (ICP) normalized, and the patient was weaned off all pressors within hours. The modified Rankin score at 3 and 12 months was 5.

Conclusions

Delayed rescue hemicraniectomy can be life-saving after poor grade SAH. The role of multimodality brain monitoring for determining the optimal timing of hemicraniectomy deserves further study.

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Titel: Multimodality Neuromonitoring and Decompressive Hemicraniectomy After Subarachnoid Hemorrhage
verfasst von: Robert Morgan Stuart
Jan Claassen
Michael Schmidt
Raimund Helbok
Pedro Kurtz
Luis Fernandez
Kiwon Lee
Neeraj Badjatia
Stephan A. Mayer
Sean Lavine
E. Sander Connolly
Publikationsdatum: 01.08.2011
Verlag: Humana Press Inc
Erschienen in: Neurocritical Care / Ausgabe 1/2011
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-009-9264-2

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