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Closure intracranial pressure as a determinant of surgical decompression adequacy in spontaneous supratentorial intracerebral haematoma: a multicentre observational study

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Abstract

Purpose

Despite significant advances, the literature on the optimal surgical treatment for spontaneous supratentorial intracerebral haematoma (ICH) remains lacking. Intraoperative ICP measured on closure (closure ICP) was reported to be a potential marker of adequate decompression in various neurosurgical conditions. We hypothesize that closure ICP also correlates with outcomes in ICH.

Methods

A multicentre retrospective study of 203 decompressive surgeries performed for ICHs was conducted (clot evacuation with either craniectomy or craniotomy). Receiver operating characteristic analysis on closure ICP was performed and an optimal threshold of 5 separated the patients into inadequate (iICP; ICP > 5 mmHg) and good decompression (gICP; ICP ≤ 5 mmHg). Postoperative ICP control, modified Rankin scale (mRS) and mortality were reported.

Results

There were 85 patients in the iICP and 118 patients in the gICP group respectively. The mean age, median preoperative Glasgow coma scale, ICH laterality, location, and volume were similar. After multivariable analysis, the need for (OR 2.55 [1.31–4.97]) and the duration of postoperative hyperosmolar therapy (iICP: 3 days, gICP: 1 day; p = 0.045), and repeat surgery for refractory ICP (OR 5.80 [1.53–22]) were more likely in the iICP group. The likelihood of mRS improvement at 1-year follow up was significantly worse in the iICP group (OR 0.38 [0.17–0.83], p = 0.015).

Conclusion

Closure ICP is an objective and reproducible surgical target. When planning for surgical decompression, obtaining closure ICP of ≤ 5 mmHg is potentially able to improve postoperative ICP management and optimise functional recovery in a well selected patient population.

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Data Availability

This data is original and available upon request.

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Authors and Affiliations

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

    Jia Xu Lim, Nivedh Dinesh, Jiani Sherry Liu, Rambert Wee, Sukit Shu Kiat Chan, Julian Xinguang Han & Min Wei Chen

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  1. Jia Xu Lim
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  2. Nivedh Dinesh
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  3. Jiani Sherry Liu
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Correspondence to Jia Xu Lim.

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Jia Xu Lim and Nivedh Dinesh are co-first authors.

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Lim, J.X., Dinesh, N., Liu, J.S. et al. Closure intracranial pressure as a determinant of surgical decompression adequacy in spontaneous supratentorial intracerebral haematoma: a multicentre observational study. Acta Neurochir 165, 3805–3813 (2023). https://doi.org/10.1007/s00701-023-05790-5

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