INTRACRANIAL PRESSURE MONITORING IN POOR-GRADE PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE TREATED BY COILING
OBJECTIVES The main objective of this study was to analyze intracranial (ICP) and cerebral perfusion pressure (CPP) changes during coiling. We also evaluated the prevalence of rebleeding and outcome in patients monitored earlier (before coiling) and in patients monitored later, after coiling. METHODS Ninety-nine consecutive poor-grade patients with aneurysmal subarachnoid hemorrhage (aSAH) (grades IV-V of the WFNS) were enrolled in this prospective observational study. In 31 patients ICP/CPP monitoring started immediately after diagnosis of aSAH and values were recorded every 15 minutes during coiling (early ICP group), while in 68 patients ICP/CPP were monitored after coiling (late ICP group). Outcome was evaluated at 90 days using the modified Rankin Scale. RESULTS At the beginning of coiling, ICP was more than 20 mmHg in 10 (35.7%) patients, and median ICP was 18 mmHg (range 5-60); CPP was less than 60 mmHg in 6 patients (24%) and median CPP was 70 mmHg (range 30-101). Despite the medical treatment and/or cerebrospinal fluid drainage, 51.6% of patients monitored during coiling had at least one episode of intracranial hypertension (defined as ICP>20 mmHg) and 51.6% had at least one episode of reduced CPP (defined as CPP<60 mmHg). Early monitoring (before aneurysm repair) was not associated with rebleeding. At 90 days the functional recovery was better in the early ICP group (p=0.004). CONCLUSIONS During coiling, patients with poor-grade aSAH may develop episodes of intracranial hypertension and reduced CPP. Early and appropriate treatment of elevated ICP was not associated with rebleeding and might have improved the outcome.
as reported in: World Neurosurg. 2021 Sep 11 [Epub ahead of print]