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Neurosurgical Procedures in Patients with Cirrhosis and Acute Liver Failure: Indications, Safety, and Feasibility of Intracranial Pressure Monitor Devices

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Surgical Procedures on the Cirrhotic Patient

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Abstract

Hepatic encephalopathy (HE) is highly associated with elevated intracranial pressure (ICP), as well as hemorrhagic complications associated with liver failure related coagulopathy. To date, invasively ICP monitoring in affected patients has been somewhat controversial because of potential complications, specifically the risk of hemorrhage associated with implantation of the monitoring device, and the paucity of evidence showing the benefit of ICP monitoring. The true risk of hemorrhage remains unknown, as the literature has shown that the risk may be high or low, depending on the study. Therefore, the risk is likely contingent on the protocol and management strategies. Despite this controversy, invasive ICP monitoring remains the most accurate means of tracking a patient’s ICP and could potentially provide benefit in some patients, though the profile of such patients is yet to be elucidated.

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Authors and Affiliations

  1. Department of Neurosurgery, Cleveland Clinic, Neurological Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Jeffrey P. Mullin MD, MBA & Edward C. Benzel MD

  2. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Connor Wathen BS

  3. Medical College of Wisconsin, Milwaukee, WI, USA

    Alvin Chan BS

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  1. Jeffrey P. Mullin MD, MBA
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Correspondence to Edward C. Benzel MD .

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  1. Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA

    Bijan Eghtesad

  2. Department of Surgery, University of Chicago, Chicago, Illinois, USA

    John Fung

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Mullin, J.P., Wathen, C., Chan, A., Benzel, E.C. (2017). Neurosurgical Procedures in Patients with Cirrhosis and Acute Liver Failure: Indications, Safety, and Feasibility of Intracranial Pressure Monitor Devices. In: Eghtesad, B., Fung, J. (eds) Surgical Procedures on the Cirrhotic Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-52396-5_21

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