Preliminary experience with controlled lumbar drainage in medically refractory intracranial hypertension

摘要: INTRODUCTION The contribution of brain edema to swelling in cases traumatic injury remains a critical problem. In head injury, the and eventual rise intracranial pressure is frequent cause death, survivors poor prognosis with sustained elevation ICP has been well documented. OBJECTIVE objective this study was evaluate effect controlled lumbar cerebrospinal fluid drainage adult patients refractory hypertension following severe injury. METHOD involved 10 injured (GCS < or = 8) medically hypertension. Aggressive treatment included repeated steps Brain Trauma Foundation's guidelines, barbiturate coma many decompressive craniectomy as well. After institution drain, maintained under control (ICP) neurological status. cerebral perfusion before after initiation related complications were RESULTS All demonstrated an immediate decrease (from 30.6 +/- 4.7 mm Hg 11.5 3.9 Hg, mean SD) concomitant increase pressure. seven long lasting 5 them had favourable outcome. Two survived permanent neurologic deficit only three died because progressive edema, which developed despite maximum therapy. CONCLUSION conclusion we may consider, that potentially useful when maximal medical therapy ventricular evacuation have failed high danger herniation minimized by considering presence discernible basilar cisterns only.