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Subdural Intracranial Pressure and Degree of Swelling After Opening of Dura in Patients with Supratentorial Tumours

  • Mads Rasmussen
  • Georg E. Cold
Chapter

Abstract

During craniotomy for a mass-expanding cerebral process such as tumour or haematoma, opening of dura mater represents a critical moment. Cerebral swelling through the craniotomy can seriously jeopardize surgical access and increase the risk of cerebral ischaemia with possible worsening of the outcome. Traditionally, preoperative CT data together with the neurological examination and level of consciousness are used to assess the risk of high ICP. As a consequence, the neurosurgeon together with the anaesthesiologist may decide whether ICP-reducing therapy is indicated before opening of the dura and exposing of the brain. In this chapter two studies of the relationship between subdural ICP and the degree of cerebral swelling after opening of dura mater are presented. The first study examined the relationship between subdural ICP before opening of the dura mater and the dural tension and degree of brain swelling in patients undergoing craniotomy for cerebral tumours or subarachnoid haemorrhage. In the second study we further investigated the relationship between subdural ICP and the degree of brain swelling in a larger population of patients.

Keywords

Subarachnoid Haemorrhage Dura Mater Midline Shift Cerebral Tumour Supratentorial Tumour 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Bedford RF, Morris L, Jane JA (1982) Intracranial hypertension during surgery for supratentorial tumour: correlation with preoperative computed tomography scans. Anesth Analg 61:430–433PubMedCrossRefGoogle Scholar
  2. Bundgaard H, Cold GE (2000) Studies of regional subdural pressure gradients during craniotomy. Br J Neurosurg 14:229–234PubMedCrossRefGoogle Scholar
  3. Bundgaard H, Landsfeldt U, Cold GE (1998) Subdural monitoring of ICP during craniotomy: thresholds of cerebral swelling/herniation. Acta Neurochir Suppl 71:276–278PubMedGoogle Scholar
  4. Cold GE, Tange M, Jensen TM et al (1996) Subdural pressure measurement during craniotomy. Correlation with tactile estimation of dural tension and brain herniation after opening of dura. Br J Neurosurg 10:69–75PubMedCrossRefGoogle Scholar
  5. Jorgensen HA, Bundgaard H, Cold GE (1999) Subdural pressure measurement during posterior fossa surgery. Correlation studies of brain swelling/herniation after dural incision with measurement of subdural pressure and tactile estimation of dural tension. Br J Neurosurg 13:449–453PubMedGoogle Scholar
  6. Narotam PK, van Dellen JR, Gouws E (1993) The role of contralateral ventricular dilatation following surgery for intracranial mass lesions. Br J Neurosurg 7:281–286PubMedCrossRefGoogle Scholar
  7. Rasmussen M, Tankisi T, Cold GE (2004) The effects of indomethacin on intracranial pressure and cerebral haemodynamics in patients undergoing craniotomy. A randomised prospective study. Anaesthesia 59:229–236PubMedCrossRefGoogle Scholar
  8. Rasmussen M, Bundgaard H, Cold GE (2004) Craniotomy for supratentorial brain tumours: risk factors for brain swelling after opening of dura mater. J Neurosurg 101:621–626PubMedCrossRefGoogle Scholar
  9. Todd MM, Warner DS, Sokoll MD et al (1993) A prospective, comparative trial of three anesthetics for elective supratentorial craniotomy: propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide. Anesthesiology 78:1005–1020PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2008

Authors and Affiliations

  • Mads Rasmussen
    • 1
  • Georg E. Cold
    • 2
  1. 1.Department of NeuroanaesthesiaAarhus University HospitalAarhus CDenmark
  2. 2.Aarhus VDenmark

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