Intracranial Hypertension with Patent Basal Cisterns: Controlled Lumbar Drainage as a Therapeutic Option. Selected Case Series,Neurocritical Care

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Intracranial Hypertension with Patent Basal Cisterns: Controlled Lumbar Drainage as a Therapeutic Option. Selected Case Series
Neurocritical Care ( IF 3.1 ) Pub Date : 2023-11-07 , DOI: 10.1007/s12028-023-01878-z
Pedro Grille ₁ , Alberto Biestro ₂ , Harold L Rekate ₃

Affiliation

Background

There are pathological conditions in which intracranial hypertension and patent basal cisterns in computed tomography coexist. These situations are not well recognized, which could lead to diagnostic errors and improper management.

Methods

We present a retrospective case series of patients with traumatic brain injury, subarachnoid hemorrhage, and cryptococcal meningitis who were treated at our intensive care unit. Criteria for deciding placement of an external lumbar drain were (1) intracranial hypertension refractory to osmotherapy, hyperventilation, neuromuscular blockade, intravenous anesthesia, and, in some cases, decompressive craniectomy and (2) a computed tomography scan that showed open basal cisterns and no mass lesion.

Results

Eleven patients were studied. Six of the eleven patients treated with controlled lumbar drainage are discussed as illustrative cases. All patients developed intracranial hypertension refractory to maximum medical treatment, including decompressive craniectomy in Four of the eleven cases. Controlled external lumbar drainage led to immediate and sustained control of elevated intracranial pressure in all patients, with good neurological outcomes. No brain herniation, intracranial bleeding, or meningitis was detected during this procedure.

Conclusions

Our study provides preliminary evidence that in selected patients who develop refractory intracranial hypertension with patent basal cisterns and no focal mass effect on computed tomography, controlled lumbar drainage appears to be a therapeutic option. In our study there were no deaths or complications. Prospective and larger studies are needed to confirm our results.

中文翻译：

具有专利基底池的颅内高压：控制腰椎引流作为治疗选择。精选案例系列

背景

在某些病理情况下，颅内高压和计算机断层扫描显示的基底池未闭同时存在。这些情况没有得到很好的认识，可能会导致诊断错误和管理不当。

方法

我们介绍了在重症监护病房接受治疗的创伤性脑损伤、蛛网膜下腔出血和隐球菌性脑膜炎患者的回顾性病例系列。决定放置外部腰大引流的标准是（1）渗透疗法、过度通气、神经肌肉阻滞、静脉麻醉以及某些情况下的去骨瓣减压术难以治疗的颅内高压；（2）计算机断层扫描显示基底池开放且无肿块性病变。

结果

对 11 名患者进行了研究。十一名接受控制腰大引流治疗的患者中的六名作为说明性病例进行讨论。所有患者均出现颅内高压，难以接受最大程度的药物治疗，其中 11 例中有 4 例接受了去骨瓣减压术。受控的腰椎外引流使所有患者的颅内压升高得到立即和持续的控制，并取得了良好的神经学结果。在此过程中未发现脑疝、颅内出血或脑膜炎。