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Treatment of intracranial hypertension

Analysis of 105 consecutive, continuous recordings of intracranial pressure

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Summary

One hundred and five consecutive recordings of intracranial pressure (ICP) in 95 patients over a three-year period, using a Scott cannula inserted through a burr hole or a twist drill hole into the anterior horn of the lateral ventricle, represent the patient material for this report. The clinical diagnoses were head injury32, intracranial tumour31, aneurysm and arteriovenous malformation18, brain swelling secondary to systemic disease8, and brain swelling of unknown etiology6. ICP exceeded 20 mm/Hg in 86 of the recordings (maximum 110 mm/Hg). Hypertonic mannitol was administered 73 times in 48 patients. ICP was reduced 10% or more (mean 52%) in all but three administrations. The effect of hyperventilation was tested in 50 trials in 34 patients. ICP was reduced 10% or more (mean 47%) in 34 trials. The mean time to maximum reduction of ICP was eight minutes, and ICP returned to control almost immediately after cessation of hyperventilation. Hypothermia was studied in 40 trials in 40 patients. ICP was reduced 10% or more (mean 51%) in half the patients. The infection rate was 6.3% in this four-hospital setting, but four of the six infections were in one hospital. If this hospital is excluded, the infection rate is 3.1%.

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Author notes

  1. H. E. James M.D.

    Present address: Division of Neurosurgery, University of Kentucky Medical Center, 40506, Lexington, KY, USA

Authors and Affiliations

  1. Division of Neurosurgery, University of Pennsylvania, USA

    H. E. James M.D., Th. W. Langfitt, V. S. Kumar & S. Y. Ghostine

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  1. H. E. James M.D.
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  2. Th. W. Langfitt
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  3. V. S. Kumar
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  4. S. Y. Ghostine
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James, H.E., Langfitt, T.W., Kumar, V.S. et al. Treatment of intracranial hypertension. Acta neurochir 36, 189–200 (1977). https://doi.org/10.1007/BF01405391

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