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Closure intracranial pressure is an objective intraoperative determinant of the adequacy of surgical decompression in traumatic acute subdural haematoma: a multicentre observational study

  • Original Article - Brain trauma
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Abstract

Purpose

Acute subdural haematoma (ASDH) is associated with severe traumatic brain injury and poor outcomes. Although guidelines exist for the decompression of ASDH, the question of adequate decompression remains unanswered. The authors examined the relationship of intracranial pressure (ICP) on closure with outcomes to determine its utility in the determination of adequate ASDH decompression.

Methods

A multicentre retrospective review of 105 consecutive patients with ASDH who underwent decompressive surgery was performed. Receiver operating characteristic (ROC) analysis with internal validation was performed to determine an ICP threshold for the division of patients into the inadequate and good ICP groups. Multivariable analyses were performed for both inpatient and long-term outcomes.

Results

An ICP threshold of 10 mmHg was identified with a 91.5% specificity, 45.7% sensitivity, and a positive and negative predictive value of 80.8% and 68.4%. There were 26 patients (24.8%) and 79 patients (75.2%) in the inadequate and good ICP groups, respectively. After adjustment, the inadequate ICP group was associated with increased postoperative usage of mannitol (OR 14.2, p < 0.001) and barbiturates (OR 150, p = 0.001). Inadequate ICP was also associated with increased inpatient mortality (OR 24.9, p < 0.001), and a lower rate of favourable MRS at 1 year (OR 0.08, p = 0.008). The complication rate was similar amongst the groups.

Conclusions

Closure ICP is a novel, objective, and actionable intraoperative biomarker that correlates with inpatient and long-term outcomes in ASDH. Various surgical manoeuvres can be undertaken to achieve this target safely. Large-scale prospective studies should be performed to validate this ICP threshold.

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Author information

Author notes

  1. Jia Xu Lim and Sherry Jiani Liu contributed equally to this study and are hence listed as co-first authors.

Authors and Affiliations

  1. Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore

    Jia Xu Lim, Sherry Jiani Liu, Tien Meng Cheong, Seyed Ehsan Saffari, Julian Xinguang Han & Min Wei Chen

  2. Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore

    Seyed Ehsan Saffari

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  1. Jia Xu Lim
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  2. Sherry Jiani Liu
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  3. Tien Meng Cheong
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  4. Seyed Ehsan Saffari
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  5. Julian Xinguang Han
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  6. Min Wei Chen
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Contributions

JXL and MWC contributed to study conception and design. Data collection was performed by SJL and TMC. Data analysis was performed by JXL, SES, and JXH. The manuscript draft was written by JXL, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jia Xu Lim.

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This article is part of the Topical Collection on Brain trauma

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Lim, J.X., Liu, S.J., Cheong, T.M. et al. Closure intracranial pressure is an objective intraoperative determinant of the adequacy of surgical decompression in traumatic acute subdural haematoma: a multicentre observational study. Acta Neurochir 164, 2741–2750 (2022). https://doi.org/10.1007/s00701-022-05270-2

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  • DOI: https://doi.org/10.1007/s00701-022-05270-2

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