Intraoperative Intracranial Pressure Monitoring for Early Detection of Delayed Intracranial Hematoma: A Report of 3 Cases

以術中顱內壓監視早期診斷顱內出血之三病例報告

葉聰志(Tsung-Chih Yeh) ； 郭進榮(Jinn-Rung Kuo) ； 邱仲慶(Chung-Ching Chio)

《Formosan Journal of Surgery》 39卷1期 (2006/02) Pp. 28-32

https://doi.org/10.29833/FJS.200602.0005

摘要

由2002年十二月至2003年十月，共有30位因硬腦膜下或硬腦膜上或腦實質出血病人，昏迷指數小於等於8，接受緊急開顱清除血塊手術，並於術中在出血同側額葉置入顱內壓監視器，連續記錄平均動脈壓，顱內壓及大腦灌流壓。有三位病人於血塊清除後，非預期地發生顱內壓上升，第一位有同側硬腦膜下出血，中第二位有顳葉肌肉出血致血塊堆積於帽狀腱膜下，第三位有對側硬腦膜外出血，同時間病人之大腦灌流壓下降至非常低。此結果顯示，術中顱內壓監視器對於嚴重頭部外傷病人非常重要，它可以讓外科醫師早期偵測出進行中的顱內出血，給予病人適當之處置，以挽救病人生命。

並列摘要

Between December 2002 and October 2003, 30 patients with acute subdural hemorrhage (SDH) and/or epidural hemorrhage (EDH), and/or intracerebral hemorrhage (ICH) underwent emergency surgery for hematoma evacuation and were admitted to our institution, the Neurosurgical Intensive Care Unit of Chi-Mei Medical Center. The intracranial pressure (ICP) monitor was inserted in the frontal lobe on the lesion side if the pre-operative Glasgow Coma Scale (GCS) was ≤8. The ICP, cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) were continuously measured throughout the entire procedure. We encountered three cases where the ICP was unexpectedly elevated after evacuation of the hematoma with simultaneous abrupt decreases in CPP to a very low level. The first case had an enlarged ipsilateral SDH, the second had a subgaleal hemorrhage caused by bleeding in the temporalis muscle; and the third, a contra-lateral EDH. We suggest that ICP monitoring, especially intraoperatively, is beneficial for cases of severe head injury, since it facilitates early detection of ongoing intracranial events such as delayed hemorrhage, and so that the appropriate emergency procedures can be initiated.

並列關鍵字

head injury ； intracranial pressure monitor ； cerebral perfusion pressure