scholarly journals Effect of Robot-Assisted Neuroendoscopic Hematoma Evacuation Combined Intracranial Pressure Monitoring for the Treatment of Hypertensive Intracerebral Hemorrhage

2021 ◽  
Vol 12 ◽  
Author(s):  
Shiqiang Wu ◽  
Heping Wang ◽  
Junwen Wang ◽  
Feng Hu ◽  
Wei Jiang ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracerebral Hemorrhage ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Icp Monitoring ◽  
Robot Assisted ◽  
Hematoma Evacuation ◽  
Significant Difference ◽  
Monitoring Group ◽  
Hypertensive Intracerebral Hemorrhage

Objective: This study aimed to investigate the clinical efficacy of robot-assisted neuroendoscopic hematoma evacuation combined intracranial pressure (ICP) monitoring for the treatment of hypertensive intracerebral hemorrhage (HICH).Patients and Methods: A retrospective analysis of 53 patients with HICH undergoing neuroendoscopic hematoma evacuation in our department from January 2016 to December 2020 was performed. We divided the patients into two groups: the neuroendoscopic group (n = 32) and the robot-assisted neuroendoscopic combined ICP monitoring group (n = 21). Data on clinical characteristics, treatment effects, and outcomes were retrospectively reviewed and analyzed between these two groups.Results: The operation time of the procedure of the neuroendoscopic group was significantly longer than that of the robot-assisted neuroendoscopic combined ICP-monitoring group (mean time 153.8 ± 16.8 vs. 132.8 ± 15.7 min, P < 0.001). The intraoperative blood loss was significantly less in the robot-assisted neuroendoscopic combined ICP-monitoring group than in the neuroendoscopic group (215.4 ± 28.3 vs. 190.1 ± 25.6 ml, P = 0.001). However, the patients undergoing neuroendoscopic had a comparable hematoma clearance rate with those undergoing robot-assisted neuroendoscopic combined ICP monitoring (85.2 ± 4.8 vs. 89.2 ± 5.4%, P = 0.997). The complications rate was greater in the endoscopic group (25%) than in the robot-assisted neuroendoscopic combined ICP-monitoring group (9.5%) but without significant difference (P = 0.159). We also found that the dose of used mannitol was significantly less in the ICP monitoring group (615.2 ± 63.8 vs. 547.8 ± 65.3 ml, P < 0.001) and there was a significant difference in modified Rankin scale (mRS) score at discharge, patients with less mRS score in the robot-assisted neuroendoscopic combined ICP monitoring group than in the neuroendoscopic group (3.0 ± 1.0 vs. 3.8 ± 0.8, p = 0.011). Patients undergoing robot-assisted neuroendoscopic combined ICP monitoring had better 6-month functional outcomes, and there was a significant difference between the two groups (p = 0.004). Besides, multivariable analysis shows younger age, no complication, and robot-assisted neuroendoscopic combined ICP monitoring were predictors of 6-month favorable outcomes for the patients with HICH.Conclusion: Robot-assisted neuroendoscopic hematoma evacuation combined with ICP monitoring appears to be safer and more effective as compared to the neuroendoscopic hematoma evacuation in the treatment of HICH. Robot-assisted neuroendoscopic hematoma evacuation combined with ICP monitoring might improve the clinical effect and treatment outcomes of the patients with HICH.

scholarly journals Clinical Application of ICP Monitoring Based on FVEP in Treatment of Patients with Hypertensive Intracerebral Hemorrhage

2020 ◽  
Author(s):  
Fangping Yu ◽  
Zhao Ying-chun ◽  
Zhang Yu ◽  
Luan Xing-hua ◽  
Wu Ying
Keyword(s):  
Intracranial Pressure ◽  
Intracerebral Hemorrhage ◽  
Lumbar Puncture ◽  
Statistical Significance ◽  
Control Group ◽  
Monitoring Technology ◽  
Urea Nitrogen ◽  
Monitoring Group ◽  
Hypertensive Intracerebral Hemorrhage ◽  
Experimental Group

Abstract ObjectiveTo investigate the application value of flash visual evoked potential (FVEP) in the monitoring of the noninvasive intracranial pressure (nICP) in patients with hypertensive intracerebral hemorrhage (HICH).MethodsOne hundred and two patients with HICH were randomly divided into FVEP nICP monitoring group (experimental group) and the non-monitoring group (control group). The experimental group were examined lumbar puncture immediately after intracranial pressure was monitored by FVEP. Mannitol was used to dehydration treatment of intracranial hypertension patients. The serum concentrations of creatinine and urea nitrogen were recorded to assess the renal function. Using the mannitol usage to evaluate the value of FVEP nICP monitoring techniques in guiding the adjustment of dehydrating agent. The Glasgow prognosis scores (GOS) were evaluated for patients' prognosis between two groups. ResultsThere was no statistical significance between FVEP nICP measurement and lumbar puncture intracranial pressure measurement (195.76 ±13.24 mmH2O vs 197.04 ±11.98 mmH2O, P>0.05). The use of mannitol in the experimental group was significantly lower than that in the control group (P< 0.05), and the serum creatinine and urea nitrogen concentrations in the two groups were not statistically significant (P> 0.05). The cure rate of the experimental group was higher than that of the control group (χ2=3.889, P=0.048). ConclusionFVEP nICP monitoring technology could replace invasive intracranial pressure monitoring technology in monitoring intracranial pressure for HICH patients. The application of FVEP nICP technique can reduce the dosage of dehydrating mannitol and improve the prognosis of patients with HICH.

scholarly journals The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature

2014 ◽  
Vol 14 (6) ◽  
pp. 674-681 ◽  
Author(s):  
Steven A. Wall ◽  
Gregory P. L. Thomas ◽  
David Johnson ◽  
Jo C. Byren ◽  
Jayaratnam Jayamohan ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Nonoperative Management ◽  
Raised Intracranial Pressure ◽  
Corrective Surgery ◽  
Icp Monitoring ◽  
Noninvasive Method ◽  
Radiological Findings ◽  
Indication For Surgery ◽  
Sagittal Craniosynostosis ◽  
Significant Difference

Object The presence of raised intracranial pressure (ICP) in untreated nonsyndromic, isolated sagittal craniosynostosis (SC) is an important functional indication for surgery. Methods A retrospective review was performed of all 284 patients presenting with SC to the Oxford Craniofacial Unit between 1995 and 2010. Results Intraparenchymal ICP monitoring was performed in 39 children following a standard unit protocol. Monitoring of ICP was offered for all patients in whom nonoperative management was considered on the basis of minimal deformity or in cases in which parents were reluctant to agree to corrective surgery. These patients presented at an older age than the rest of the cohort (mean age 56 months), with marked scaphocephaly (16/39, 41%), mild scaphocephaly (11, 28%), or no scaphocephalic deformity (12, 31%). Raised ICP was found in 17 (44%) patients, with no significant difference in its incidence among the 3 different deformity types. Raised ICP was not predicted by the presence of symptoms of ICP or developmental delay or by ophthalmological or radiological findings. Conclusions The incidence of raised ICP in SC reported here is greater than that previously published in the literature. The lack of a reliable noninvasive method to identify individuals with elevated ICP in SC mandates consideration of intraparenchymal ICP monitoring in all patients for whom nonoperative management is contemplated.

Decompressive Craniectomy with Hematoma Evacuation for Large Hemispheric Hypertensive Intracerebral Hemorrhage

2013 ◽  
pp. 277-279 ◽  
Author(s):  
Satoru Takeuchi ◽  
Yoshio Takasato ◽  
Hiroyuki Masaoka ◽  
Takanori Hayakawa ◽  
Hiroshi Yatsushige ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Decompressive Craniectomy ◽  
Hematoma Evacuation ◽  
Hypertensive Intracerebral Hemorrhage

Abstract TP329: Early Initiation of Oral Antihypertensives Reduces Intensive Care Unit Stay and Hospital Cost in Patients With Hypertensive Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Zhu Zhu ◽  
Matthew Bower ◽  
Sara Stern-Nezer ◽  
Steven Atallah ◽  
Dana Stradling ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intracerebral Hemorrhage ◽  
Resource Utilization ◽  
Hospital Cost ◽  
Early Initiation ◽  
Control Group ◽  
Study Group ◽  
Significant Difference ◽  
Hypertensive Intracerebral Hemorrhage

Background and Purpose: Intravenous nicardipine infusion is effective for intensive blood pressure (BP) control in patients with hypertensive intracerebral hemorrhage (ICH). However, its use requires close hemodynamic monitoring in the intensive care unit (ICU). Prompt transition from nicardipine infusion to oral antihypertensives may reduce ICU length of stay (LOS). This study aimed to examine the effect of early verse late initiation of oral antihypertensives on hospital resource utilization in patients with hypertensive ICH. Methods: This is a retrospective study of patients with hypertensive ICH and initial systolic BP ≥ 180 mmHg from January 1, 2013 to December 31, 2017. Only patients who received nicardipine infusion were included. Based on timing of receiving oral antihypertensives within or after 24 hours of emergency department arrival, patients were divided into study or control group, respectively. Baseline characteristics, duration of nicardipine infusion, ICU and hospital LOS, functional outcome at hospital discharge, and the cost were compared between the 2 groups using univariate and multivariate analysis to adjust for dependent variables. Results: A total of 166 patients (90 in study group, 76 in control group) were identified. There was no significant difference in demographic features, past medical history or initial SBP between the 2 groups. Patients in study group had lower initial NIHSS and ICH scores but higher GCS score than those in the control group. Using multivariant regression analysisto adjust for initial SBP, NIHSS, GCS and ICH scores, early initiation of oral antihypertensives was associated with significant shorter ICU LOS (median 2 vs 5, p =0.004), decreased duration of nicardipine infusion (55.5 ±60.1 vs 121.6 ±141.3, P =0.002), less pharmaceutical cost (median $14207 vs $ 29299, p =0.007) and total hospital cost (median $ 24564 vs $ 47366, p =0.007). After adjustment of confounders, there was also no significant difference in functional independence (mRS 0-2, 42.2% vs 17.1%, p =0.112) or mortality (6.7% vs 13.2%, p = 0.789) between the 2 groups. Conclusions: Early initiation of oral antihypertensive therapy is associated with reduced resource utilization and hospital cost in patients with hypertensive ICH.

scholarly journals Relationship between Intracranial Pressure Monitoring and Outcomes in Severe Traumatic Brain Injury Patients

2011 ◽  
Vol 39 (6) ◽  
pp. 1043-1050 ◽  
Author(s):  
S. Haddad ◽  
A. S. Aldawood ◽  
A. Alferayan ◽  
N. A. Russell ◽  
H. M. Tamim ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Intracranial Pressure ◽  
Hospital Mortality ◽  
Icp Monitoring ◽  
Icu Mortality ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Significant Difference ◽  
Severe Tbi

Intracranial pressure (ICP) monitoring is recommended in patients with a severe traumatic brain injury (TBI) and an abnormal computed tomography (CT) scan. However, there is contradicting evidence about whether ICP monitoring improves outcome. The purpose of this study was to examine the relationship between ICP monitoring and outcomes in patients with severe TBI. From February 2001 to December 2008, a total of 477 consecutive adult (>18 years) patients with severe TBI were included retrospectively in the study. Patients who underwent ICP monitoring (n=52) were compared with those who did not (n=425). The primary outcome was hospital mortality. Secondary outcomes were ICU mortality, mechanical ventilation duration, the need for tracheostomy, and ICU and hospital length of stay (LOS). After adjustment for multiple potential confounding factors, ICP monitoring was not associated with significant difference in hospital or ICU mortality (odds ratio [OR]=1.71, 95% confidence interval [CI]=0.79 to 3.70, P=0.17; OR=1.01, 95% CI=0.41 to 2.45, P=0.99, respectively). ICP monitoring was associated with a significant increase in mechanical ventilation duration (coefficient=5.66, 95% CI=3.45 to 7.88, P <0.0001), need for tracheostomy (OR=2.02, 95% CI=1.02 to 4.03, P=0.04), and ICU LOS (coefficient=5.62, 95% CI=3.27 to 7.98, P <0.0001), with no significant difference in hospital LOS (coefficient=8.32, 95% CI=-82.6 to 99.25, P=0.86). Stratified by the Glasgow Coma Scale score, ICP monitoring was associated with a significant increase in hospital mortality in the group of patients with Glasgow Coma Scale 7 to 8 (adjusted OR=12.89, 95% CI=3.14 to 52.95, P=0.0004). In patients with severe TBI, ICP monitoring was not associated with reduced hospital mortality, however, with a significant increase in mechanical ventilation duration, need for tracheostomy, and ICU LOS.

Decreased risk of acute kidney injury with intracranial pressure monitoring in patients with moderate or severe brain injury

2013 ◽  
Vol 119 (5) ◽  
pp. 1228-1232 ◽  
Author(s):  
Jingsong Zeng ◽  
Wusong Tong ◽  
Ping Zheng
Keyword(s):  
Acute Kidney Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cystatin C ◽  
Kidney Injury ◽  
Control Group ◽  
Icp Monitoring ◽  
Blood Concentrations ◽  
Brain Trauma Foundation ◽  
Monitoring Group

Object The authors undertook this study to evaluate the effects of continuous intracranial pressure (ICP) monitoring–directed mannitol treatment on kidney function in patients with moderate or severe traumatic brain injury (TBI). Methods One hundred sixty-eight patients with TBI were prospectively assigned to an ICP monitoring group or a conventional treatment control group based on the Brain Trauma Foundation guidelines. Clinical data included the dynamic changes of patients' blood concentrations of cystatin C, creatinine (Cr), and blood urea nitrogen (BUN); mannitol use; and 6-month Glasgow Outcome Scale (GOS) scores. Results There were no statistically significant differences with respect to hospitalized injury, age, or sex distribution between the 2 groups. The incidence of acute kidney injury (AKI) was higher in the control group than in the ICP monitoring group (p < 0.05). The mean mannitol dosage in the ICP monitoring group (443 ± 133 g) was significantly lower than in the control group (820 ± 412 g) (p < 0.01), and the period of mannitol use in the ICP monitoring group (3 ± 3.8 days) was significantly shorter than in the control group (7 ± 2.3 days) (p < 0.01). The 6-month GOS scores in the ICP monitoring group were significantly better than in the control group (p < 0.05). On the 7th, 14th, and 21st days after injury, the plasma cystatin C and Cr concentrations in the ICP-monitoring group were significantly higher than the control group (p < 0.05). Conclusions In patients with moderate and severe TBI, ICP-directed mannitol treatment demonstrated a beneficial effect on reducing the incidence of AKI compared with treatment directed by neurological signs and physiological indicators.

N-Terminal Pro-Brain Natriuretic Peptide Concentrations After Hypertensive Intracerebral Hemorrhage: Relationship With Hematoma Size, Hyponatremia, and Intracranial Pressure

2017 ◽  
Vol 33 (12) ◽  
pp. 663-670 ◽  
Author(s):  
Fei Li ◽  
Qian-Xue Chen ◽  
Shou-Gui Xiang ◽  
Shi-Zhun Yuan ◽  
Xi-Zhen Xu
Keyword(s):  
Intracranial Pressure ◽  
Intracerebral Hemorrhage ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Linear Regression Analysis ◽  
Peak Level ◽  
Hematoma Volume ◽  
The Mean ◽  
Hypertensive Intracerebral Hemorrhage ◽  
Mean Concentration

Introduction: The role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with hypertensive intracerebral hemorrhage (HICH) is poorly understood. This study aimed to investigate the secretion pattern of NT-proBNP in patients with HICH and to assess its relationship with hematoma size, hyponatremia, and intracranial pressure (ICP). Methods: This prospective study enrolled 147 isolated patients with HICH. Blood samples were obtained from each patient, and values of serum NT-proBNP, hematoma size, blood sodium, and ICP were collected for each patient. Results: The peak-to-mean concentration of NT-proBNP was 666.8 ± 355.1 pg/mL observed on day 4. The NT-proBNP levels in patients with hematoma volume >30 mL were significantly higher than those in patients with hematoma volume <30 mL ( P < .05). In patients with severe HICH, the mean concentration of NT-proBNP was statistically higher than that in patients with mild–moderate HICH ( P < .05), and the mean level of NT-proBNP in hyponatremia group was significantly higher than that in normonatremic group ( P < .05). In addition, the linear regression analysis indicated that serum NT-proBNP concentrations were positively correlated with ICP ( r = .703, P < .05) but negatively with blood sodium levels only in patients with severe HICH ( r = −.704, P < .05). The serum NT-proBNP levels on day 4 after admission were positively correlated with hematoma size ( r = .702, P < .05). Conclusion: The NT-proBNP concentrations were elevated progressively and markedly at least in the first 4 days after HICH and reached a peak level on the fourth day. The NT-proBNP levels on day 4 were positively correlated with hematoma size. There was a notable positive correlation between plasma NT-proBNP levels and ICP in patients with severe HICH. Furthermore, only in patients with severe HICH, the plasma NT-proBNP levels presented a significant correlation with hyponatremia, which did not occur in patients with mild–moderate HICH.

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