Experience of Intracranial Pressure Monitoring in Patients after Glial Tumor Resection Following Mass Effect and Dislocation SyndromeExperience of Intracranial Pressure Monitoring in Patients after Glial Tumor Resection Following Mass Effect and Dislocati

O.Ya. Ilchyshyn, Ya.I. Dizhak


Patient N., aged 62, with the diagnosis left mediobasal fronto-temporal lobe tumor was electively hospitalized in the Hospital of Emergency care. The patient’s condition at the time of admission was moderate; level of consciousness was 14 points by the Glasgow Coma Scale (GCS); the patient complaints of mild headache, weakness in the right extremities. MRI revealed glial formation with large perifocal edema offset medial structures 7 mm. The total removal of the tumor under endotracheal anesthesia with complete muscle relaxation was electively performed. There was a significant intraoperative brain edema with large prolapse of the brain tissues. Antiedematous therapy used, increased head position at 45º were not effective enough. Given the above situation, during the operation in the subdural space PVC catheter was administered to measure and correct intracranial pressure (ICP). Postoperatively, the patient was transferred to the intensive care unit, where mechanical ventilation was prolonged in normoventilation mode (respirator iVent, Israel) and intensive care was conducted under the protocol, the vital parameters were appropriately monitored, and ICP started to be measured. ICP was monitored carried by multifunctional monitor IntelliVue Patient Monitor MP40 (Philips) of the line for invasive pressure measurement by subdural fluid-filled catheter with an external transducer reusable connectep. The patient received intensive therapy according to the current protocol, artificial ventilation, enteral nutritional support with energy value of 35 kcal/kg, antibiotic prophylaxis, prevention of thromboembolic complications, stress damage to the gastrointestinal tract, analgosedation and adaptation to mechanical ventilation (sodium hydroxybutyrate, morphine, diazepam, thiopental). If ICP increased appropriate treatment with hyperosmotic solutions (mannitol, hypertonic sodium chloride), dexamethasone and solu-medrol was performed. While patient’s treatment her consciousness recovered to the level up to 13 points by GCS. On the second day of treatment the level of consciousness of the patient was 14 points by GCS. On the third day the condition improved, the level of consciousness was 14 points by GCS, the patient was transferred to the neurosurgical department. On the tenth day the patient underwent re-operation for closing the bone flaw. The patient was discharged home in good condition, with no neurological deficit deepening. Complications associated with ICP monitoring were not determined. Conclusions. The method of ICP monitoring via subdural sensor with a standard multifunctional display is a robust, reliable, affordable and economically feasible. Implementation of ICP monitoring requires close collaboration between neurosurgeons and anesthesiologists. ICP monitoring in patients with brain tumors in the early postoperative period had a significant impact on the therapy in these patients. ICP measurement in the early postoperative period makes it possible to control edema of the brain and impact the proper selection of the therapy without traumatic transpor­ting the patient for CT examination of the brain.


intracranial pressure; edema swelling of the brain; monitoring; glial brain tumors


Белкин А.А. Патогенетическое понимание системы церебральной защиты при внутричерепной гипертензии и пути ее клинической реализации у больных с острой церебральной недостаточностью // Интенсивная терапия. — 2006. —Т. 3, № 7. — С. 127-134.

Махкамов К.Э. Роль мониторинга внутричерепного давления в прогнозировании исходов тяжелой черепно-мозговой травмы / К.Э. Махкамов, Р.С. Юнусов // Вестник экстренной медицины. — 2009. — № 3. — С. 45-49.

Моніторинг внутрішньочерепного тиску у потерпілих з тяжкою черепно-мозковою травмою (огляд літератури та аналіз власних спостережень) / Л.А. Дзяк, М.О. Зорін, А.Г. Сірко та співавт. // Український нейрохірургічний журнал. — 2008. — № 1. — С. 17-22.

Нейрофизиологический мониторинг интенсивной терапии в остром периоде тяжелой черепно-мозговой травмы / В.И. Черний, Г.А. Городник, А.М. Кардаш и соавт. // Медицина неотложных состояний. — 2008. — № 2 (15). — С. 72-76.

Morris K.P., Forsyth R.J., Parslow R.C. et al. Intracranial pressure complicating severe traumatic brain injury in children: monitoring and management // Intensive Care Med. — 2006. — № 32. — С. 1606-1612.

Andrews P. Intracranial pressure. Part one: Historical overview and basic concept / P. Andrews, G. Citerio // Intensive Care Med. — 2004. — Vol. 30. — P. 1730-1733.

Chambers I.R. A clinical evaluation of the Camino subdural screw and ventricular monitoring kits / I.R. Chambers, A.D. Mendelow, E.J. Sinar // Neurosurgery. — 1990. — Vol. 26. — P. 421-423.

Guidelines for the management of severe traumatic brain injury. Indications for intracranial pressure monito­ring // J. Neurotrauma. — 2007. — Vol. 24 (Suppl. 1). — P. S37-S44.

Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury / Balestreri M., Czosnyka M., Hutchinson P. et al. // Neurocrit. Care. — 2006. — Vol. 4. — P. 8-13.

Intracranial pressure monitoring using a newly developed transducer-tipped ventricular drainage catheter / H. Samejima, M. Ueda, Y. Ushikubo et al. // Neurol. Med. Chir. (Tokyo). — 1998. — Vol. 38. — P. 238-240.

Neurosurgery-Principles and Practice / Anne J. Moore, David W. Newell et al. — Springer, 2010. — P. 25-26.

Fukushima manual of skull base dissection / Takanori Fukushima, Yoichi Nonaka et al. // Neurol. Med. Chir. (Tokyo). — 2010. — P. 233-234.

Copyright (c) 2017 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2018


   Seo анализ сайта