Clinical and prognostic role of intracranial pressure monitoring in patients with aneurismal subarachnoid haemorrhage

Introduction

Intracranial hypertension (ICH) caused by brain oedema is a frequent complication of the acute aneurismal subarachnoid haemorrhage (SAH) [1]. The only adequate method of diagnosis and assessment of ICH degree is its continuous monitoring that is necessary for efficient and timely anti-edematous therapy [2].

Methods

The authors report 75 patients with SAH and risk of ICH. Intracranial pressure (ICP) monitoring was performed by 'Codman' sensors in 35 patients (Group 1). In 32 of them ICP monitoring was performed using subdural sensors, and in three of them using intraventricular sensors. In seven cases ICP monitoring was carried out in the preoperative period, and in 28 cases after AA exclusion. In 40 patients without ICP monitoring (retrospective material – Group 2) the basic methods of diagnosis were neurological examination and computed tomography (CT). Both groups were identical by sex, age, time of operative intervention, methods of intensive therapy and severity of state. The basic difference was the starting time of anti-edematous therapy.

Results

Cerebral ischemia and marked neurological deficits were more frequently observed in Group 1 compared with Group 2 (80% and 17% correspondingly, P < 0.05). Favourable outcome was 65.7% (GCS, GOS Y-IY) in Group 1 and 17.5% in Group 2. Unfavourable outcome was 34.3% (GOS III-1) in Group 1 and 77.5% in Group 2; mortality made up 25% and 22.9% correspondingly, and brain oedema was 90% and 25% correspondingly. The mortality rate was as follows: in Group 1 eight patients (22.9%) died, two of them of brain oedema, which made up 25% of all mortality cases in this group, and six patients (75%) died of SAH recurrence. In Group 2 10 patients (25%) died, one of them (10%) died of SAH recurrence and nine patients died of brain oedema, which made up 90% of all mortality cases in this group.

Conclusion

ICP monitoring in patients with aneurismal SAH allow one to reveal ICH in the early stage and to determine the cause of the increased ICP according to CT data. Besides, ICP monitoring in the acute stage of the aneurismal SAH allows timely adequate intensive care and thus evidence-based outcome improvement (P < 0.05).