| Objectives: Through the analysis of the changes of intracranial pressure before and after decompressive craniectomy in patients with high-grade aneurysmal subarachnoid hemorrhage,the efficacy of decompressive craniectomy,the evolution of intracranial pressure,and the relationship between the size of the bone flap and the decompression effect were discussed,which provided a clinical basis for the application of decompressive craniectomy in the poor-grade aneurysmal subarachnoid hemorrhage Methods: A retrospective analysis was performed on the clinical data of 23 patients with poor-grade aneurysmal subarachnoid hemorrhage who were admitted to our hospital with continuous intracranial pressure monitoring and decompression of the debony flap from January 2018 to December 2021,and the changes of intracranial pressure during and after continuous monitoring.The patient’s baseline and clinical data,preoperative,debony flap and opening of the dura,postoperative period,postoperative 6h,postoperative 12 h,postoperative 24 h,and intracranial pressure every hour for 7 consecutive days were recorded,and the patient’s prognosis was evaluated by follow-up for 6 months.Perform single-factor(multiple-factor)repeat-measure ANOVA on the data.Results: After 6 months of postoperative follow-up,4 patients died(17.4%),1 case of plant survival(4.3%),6 cases of severe disability(26.1%),2 cases of moderate disability(8.7%),10 cases were good,and the poor prognosis rate was 47.8%,and the good prognosis rate was 52.2%.The intracranial pressure before surgery,after deboning the flap and opening the dura,at the time of surgery,6 h after surgery,12 h after surgery,and 24 h after surgery were 38.35±8.94 mm Hg,15.13±4.2mm Hg,8.04±2.44 mm Hg,11.00±4.34 mm Hg,11.96±4.97 mm Hg and 13.48±6.29 mm Hg,respectively.The intracranial pressure was significantly reduced after dural opening,at the time of surgery,6 h after surgery,12 h after surgery and 24 h after surgery,and the difference was significant(p<0.001).At that time,the intracranial pressure was further reduced after surgery compared with the incision of the dura mater,and the difference was significant(p<0.001).The postoperative 12 h and 24 h postoperative increased to a certain extent compared with the postoperative period,and the difference was significant(p<0.001).The intracranial pressure in patients increased slightly 6 hours after surgery and gradually returned to normal values.The intracranial pressure in the small bone window group with a bone flap area < 90mm2(group A),the middle bone window group with a bone flap area of 90～110mm2(group B)and the large bone window group with a bone flap area of > 110mm2(group C)had the same trend at each time node,but the intracranial pressure decreased more significantly in the large bone flap group after cutting the dura.All three groups began to rise to a certain extent after surgery,but the ICP increase rate was faster in group A and group B,and the ICP increase rate was the slowest in group C.The ICP of group C began to decline 6 h after surgery,while the ICP of group A and group B began to decline 24 hours after surgery,and the intracranial pressure change trend in the group with a bone flap area > 110mm2 was more stable than that in the middle bone flap and small bone flap groups.Conclusions: The results of this study showed that intracranial pressure was significantly increased in patients with high-grade aneurysmal subarachnoid hemorrhage,and decompression of the bone flap could significantly reduce intracranial pressure in patients with high-grade aneurysmal subarachnoid hemorrhage.Intracranial pressure rises slightly after decompression of the bone flap,but is usually within the normal range.The decompression effect of large bone window(bone flap area > 110mm2)was better than that of small bone window,and the trend of intracranial pressure change after large bone window decompression was more stable than that of small bone flap. |
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