fsurg-09-823899_Data_Sheet 1_v1_Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study.pdf

BackgroundDecompressive craniectomy (DC) improves the survival and functional outcomes in patients with malignant cerebral infarction. Currently, there are no objective intraoperative markers that indicates adequate decompression. We hypothesise that closure intracranial pressure (ICP) correlates with postoperative outcomes.
MethodsThis is a multicentre retrospective review of all 75 DCs performed for malignant cerebral infarction. The patients were divided into inadequate ICP (iICP) and good ICP (gICP) groups based on a suitable ICP threshold determined with tiered receiver operating characteristic and association analysis. Multivariable logistic regression was performed for various postoperative outcomes.
ResultsAn ICP threshold of 7 mmHg was determined, with 36 patients (48.0%) and 39 patients (52.0%) in the iICP and gICP group, respectively. After adjustment, postoperative osmotherapy usage was more likely in the iICP group (OR 6.32, p = 0.003), and when given, was given for a longer median duration (iICP, 4 days; gICP, 1 day, p = 0.003). There was no difference in complications amongst both groups. When an ICP threshold of 11 mmHg was applied, there was significant difference in the duration on ventilator (ICP ≥11 mmHg, 3–9 days, ICP <11 mmHg, 3–5 days, p = 0.023).
ConclusionSurgical decompression works complementarily with postoperative medical therapy to manage progressive cerebral edema in malignant cerebral infarctions. This is a retrospective study which showed that closure ICP, a novel objective intraoperative biomarker, is able to guide the adequacy of DC in this condition. Various surgical manoeuvres can be performed to ensure that this surgical aim is accomplished.

背景：去骨瓣减压术（Decompressive Craniectomy, DC）可改善恶性脑梗死患者的生存率与功能预后。目前尚无能够提示减压充分性的客观术中标志物。本研究假设关颅时颅内压（intracranial pressure, ICP）与术后预后存在相关性。
方法：本研究为一项多中心回顾性研究，纳入全部75例因恶性脑梗死接受DC治疗的患者。根据通过分层受试者工作特征（tiered receiver operating characteristic）与关联分析确定的适宜ICP阈值，将患者分为低颅内压组（inadequate ICP, iICP）与良好颅内压组（good ICP, gICP）。针对多种术后预后指标开展多变量logistic回归（multivariable logistic regression）分析。
结果：最终确定ICP阈值为7mmHg，其中低颅内压组36例（占比48.0%），良好颅内压组39例（占比52.0%）。经校正后，低颅内压组术后渗透压治疗（osmotherapy）的使用概率更高（比值比OR=6.32，p=0.003）；若接受该治疗，其中位持续时间也更长（低颅内压组：4天；良好颅内压组：1天，p=0.003）。两组并发症发生率无显著差异。当采用11mmHg作为ICP阈值时，呼吸机辅助通气时长存在显著差异（ICP≥11mmHg组：3~9天，ICP<11mmHg组：3~5天，p=0.023）。
结论：手术减压与术后药物治疗可协同作用，用于管理恶性脑梗死患者的进行性脑水肿。本回顾性研究表明，关颅时ICP作为一种新型客观术中生物标志物，能够指导该疾病中DC手术的充分性评估。可通过多种手术操作手段确保达成这一手术目标。