The role of intracranial pressure monitoring in the treatment of craniocerebral injury with decom-pressive craniectomy
Objective To explore the role of intracranial pressure(ICP)monitoring in the treatment of traumatic brain injury(TBI)with decompressive craniectomy(DC).Methods The clinical data of 218 patients with moderate and severe TBI treated with DC in the Department of Neurosurgery,Henan Provincial People's Hospital from January 2018 to December 2022 were retrospectively analyzed.Based on the Glasgow Coma Score(GCS)within 24 h after admission,the patients with 9 to 12 points were classified as moderate TBI(mTBI,117 cases),and those with 3 to 8 points were classified as severe TBI(sTBI,101 cases).According to whether ICP monitoring was used during surgery,the patients were divided into mTBI monitoring group(57 cases),mTBI non-monitoring group(60 cases),sTBI monitoring group(50 cases),and sTBI non-monitoring group(51 cases).We then analyzed the inter-group differences in the surgical duration,intensive care unit(ICU)stay length and total hospital stay length,mannitol dosage,mechanical ventilation duration,discharge GCS,extended Glasgow Outcome Scale(GOS-E)and surgery-related complications.GOS-E was followed up 6 months after surgery,and the outcomes of GOS-E 4 to 8 points were considered as good,2 to 3 points as poor,and 1 point as death.Results Compared with the mTBI unmonitored group,patients in the mTBI monitored group had higher GCS and GOS-E at discharge,shorter ICU stay,and less mannitol usage,and the differences were statistically significant(all P＜0.05).Compared with sTBI unmonitored,the GCS and GOS-E of patients in the sTBI monitoring group were both higher at discharge,and the differences were statistically significant(both P＜0.05),while the differences in length of stay in the ICU or mannitol usage was not statistically significant(both P＞0.05).Compared with the non-monitored groups in mTBI and sTBI,the monitored groups had no statistically significant differences in operation duration,mechanical ventilation duration,or postoperative related complications(all P＞0.05).After 6 months of follow-up,the proportions of favorable outcomes in the mTBI unmonitored group and the mTBI monitored group were 50.9％(29/57)and 43.3％(26/60)respectively,and those of poor outcomes were 26.3％(15/57)and 23.3％(14/60)respectively,and the mortality rates were 22.8％(13/57)and 33.3％(20/60)respectively.The proportions of favorable outcomes in the sTBI monitored group and the sTBI unmonitored group were 50.0％(25/50)and 41.2％(21/51)respectively,those of poor outcomes were 4.0％(2/50)and 7.8％(4/51)respectively,the mortality rates were46.0％(23/50)and51.0％(26/51)respectively,and the differences were all statistically significant(all P＜0.05).Conclusion ICP monitoring in DC would not increase the duration of surgery or the incidence of surgery-related complications;it will help improve the prognosis of patients.
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