动态颅内压监测在占位性小脑梗死枕下后颅窝减压术中的应用

目的:探讨动态颅内压监测在占位性小脑梗死枕下后颅窝减压手术中的应用，分析颅内压变化规律及其对预后的影响。方法:回顾性分析了2016年10月至2020年10月，菏泽市立医院22例动态颅内压监测联合枕下后颅窝减压术治疗的占位性小脑梗死患者，其中男11例，女11例，年龄28～79（56.4±13.5）岁。手术时分别在颅内压监...

Application of dynamic intracranial pressure monitoring in suboccipital decompressive craniectomy for space-occupying cerebellar infarction

Objective　To explore the application of dynamic intracranial pressure (ICP) monitoring in suboccipital decompressive craniectomy (SDC) for space-occupying cerebellar infarction, and investigate the ICP changes and their impact on the patients' prognosis. Methods　Twenty-two patients with space-occupying cerebellar infarction treated with SDC and dynamic ICP monitoring in Heze Municipal Hospital from October 2016 to October 2020 were retrospectively analyzed, including 11 males and 11 females, and they were 28-79 (56.4±13.5) years old. When the ICP monitoring probe was put in, before decompressive craniectomy and after the cerebrospinal fluid was released, and when the surgery was over, the ICP's were measured, and recorded as ICP1, ICP2, and ICP3. The difference between ICP2 and ICP3 was recorded as ΔICP. After the surgery, the ICP was continuously and dynamically monitored, and the ICP change and its relation with prognosis were analyzed. Independent-sample t test, paired t test, and Pearson correlation analysis were applied. Results　The ICP1, ICP2, ICP3, and peak ICP were (22.3±4.3), (20.3±3.9), (15.7±3.8) and (19.4±5.2) mmHg (1 mmHg=0.133 kPa), with a statistical difference between ICP2 and ICP3 (P<0.01), and the ΔICP was (4.6±1.9) mmHg. The craniectomy area was (22.5±1.6) cm², and the ΔICP had no correlation with it (P=0.17). By the end of the follow-up period, 18 patients survived, and 4 patients died. The score of Glasgow Outcome Scale (GOS) in the patients who survived was (3.9±1.5), and 16 patients had high survival quality, and their scores of GOS ≥ 4. The peak ICP and cumulative time for postoperative ICP to exceed the threshold (CTET) had impact on the patients' prognosis (r=0.31, P<0.01). Conclusion　ICP monitoring is valuable for SDC in the treatment of space-occupying cerebellar infarction and may predict the patients' prognosis.