Study on the correlation between posterior fossa and lateral ventricular pressure after craniotomy for cerebellar infarction combined with obstructive hydrocephalus
Objective To explore the correlation between the posterior fossa pressure and lateral ventricular pressure in patients with cerebellar infarction and obstructive hydrocephalus after craniotomy,and to compare and analyze the outcomes of patients who undergo monitoring of intraventricular pressure and simultaneous monitoring of lateral ventricular and posterior fossa pressure.Methods A retrospective analysis was performed on 50 patients with cerebellar infarction combined with obstructive hydrocephalus who underwent posterior fossa craniotomy,decompressive craniectomy and external ventricular drainage at the Emergency Neurosurgery Department of Qilu Hospital of Shandong University from August 2018 to March 2023.According to clinical data,28 patients underwent postoperative intraventricular and posterior fossa pressure monitoring at the same time(as the joint monitoring group),and 22 patients only underwent intraventricular pressure monitoring(as the lateral ventricular pressure monitoring group).A simple linear regression model was used to analyze the correlation between intraventricular pressure in the joint monitoring group and pressure in the posterior fossa at the same time.Outpatient or telephone follow-up was conducted 6 months after discharge,and patients were divided into poor outcome(grade Ⅰ to Ⅲ)and good outcome(grade Ⅳ to Ⅴ)according to the Glasgow Outcome Scale(GOS).The Glasgow Coma Score(GCS),length of external ventricular drainage tube indwelling,length of hospitalization and outcomes of the two groups of patients were compared 7 days after surgery and before discharge.Results A total of 3 370 intracranial pressure data were collected from 28 patients in the joint monitoring group;the postoperative intraventricular pressure[8.53±4.48 mm Hg(1 mm Hg=0.133 kPa)]was lower than the pressure in the posterior fossa(13.47±4.12 mm Hg),and the difference was statistically significant(paired t value=104.41,P＜0.001).The simple linear regression model analysis results showed that there was a positive correlation between the pressure in the lateral ventricles and the posterior fossa(R2=0.64),and the linear regression equation was fitted as Y=0.87X-3.19(Y:lateral ventricular pressure,X:posterior fossa pressure;P＜0.001).Comparing the joint monitoring group with the lateral ventricular pressure monitoring group,there were no statistically significant differences in the length of external ventricular drainage tube indwelling,length of hospitalization,or GCS 7 days after surgery and discharge(all P＞0.05).At the 6-month follow-up after surgery,19 cases(67.9％)in the joint monitoring group had a good outcome and 9 cases(32.1％)had a poor outcome;in the lateral ventricular pressure monitoring group,14 cases(63.6％)had a good outcome and 8 cases(36.4％)had a poor outcome.Comparing the two groups,the difference of the outcomes was not statistically significant(x2=0.16,P=0.977).Conclusions There is a difference between the pressure in the posterior fossa and intraventricular pressure in patients with cerebellar infarction and obstructive hydrocephalus,and the two are positively correlated.Similar clinical outcomes can be obtained by guiding postoperative treatment based on monitoring of lateral ventricular pressure or monitoring of both lateral ventricular and posterior fossa pressure.
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