Improved Outcome from Traumatic Coma Using Only Ventricular Cerebrospinal Fluid Drainage for Intracranial Pressure Control

  • J. B. G. Ghajar
  • R. J. Hariri
  • R. H. Patterson
Part of the Advances in Neurosurgery book series (NEURO, volume 21)

Abstract

Treatment of intracranial hypertension is essential in the management of patients with traumatic brain injuries. Patients with persistently high intracranial hypertension are likely to die [1], and treatments to reduce intracranial hypertension are performed with the aim of improving cerebral perfusion. While mortality from severe head injury has been reduced from 50% to 35% over the past 15 years [2], the contribution of the treatment of elevated intracranial pressure (ICP) has never been isolated from the contributions of advances in surgical management, diagnostic radiology and general intensive unit (ICU) care. It is at least theoretically possible that the prognosis of severely head-injured patients is no better with treatment of elevated ICP than without treatment, given adequate surgical and ICU care. Similarly, the question of whether or not treatment of elevated ICP simply increases the number of vegetative survivors has never been answered directly. Commonly employed therapeutic measures to reduce ICP are hyperventilation, mannitol, barbiturates, and ventricular cerebrospinal fluid (CSF) drainage. We hypothesized that CSF drainage alone would decrease morbidity and mortality to a greater extent than other treatments because it has the potential to improve cerebral perfusion as well as decrease intracranial pressure [3]. Hyperventilation, in contrast, can potentially reduce cerebral perfusion below ischémic thresholds by vasoconstriction [4]. Osmotic diuretics [5] and barbiturates [6] can also theoretically reduce cerebral perfusion to a deleterious extent by systemic hypotension. These factors are crucial in the consideration of a traumatized brain with an already marginal blood flow, especially during the early stages of treatment [7]. However, studies of patients with severe head injury in the past 15 years have used a combination of therapies and not ventricular CSF drainage alone as the principal method of reducing increased intracranial pressure.

Keywords

Catheter Ischemia Neurol Mannitol Nial 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • J. B. G. Ghajar
    • 1
  • R. J. Hariri
    • 1
  • R. H. Patterson
    • 1
  1. 1.The Aitken Neurosurgery LaboratoryNew YorkUSA

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