Object. Medically intractable intracranial hypertension is a major cause of morbidity and mortality after severe brain injury. One potential treatment for intracranial hypertension is decompressive hemicraniectomy (DCH). Whether and when to use DCH, however, remain unclear. The authors therefore studied the effects of DCH on cerebral O2 to develop a better understanding of the effects of this treatment on the recovery from injury and disease.
Methods. The study focused on seven patients (mean age 30.6 ± 9.7 years) admitted to the hospital after traumatic brain injury (five patients) or subarachnoid hemorrhage (two patients) as part of a prospective observational database at a Level I trauma center. At admission the Glasgow Coma Scale (GCS) score was 6 or less in all patients. Patients received continuous monitoring of intracranial pressure (ICP), cerebral perfusion pressure (CPP), blood pressure, and arterial O2 saturation. Cerebral oxygenation was measured using the commercially available Licox Brain Tissue Oxygen Monitoring System manufactured by Integra NeuroSciences. A DCH was performed when the patient's ICP remained elevated despite maximal medical management.
Conclusions. All patients tolerated DCH without complications. Before the operation, the mean ICP was elevated in all patients (26 ± 4 mm Hg), despite maximal medical management. After surgery, there was an immediate and sustained decrease in ICP (19 ± 11 mm Hg) and an increase in CPP (81 ± 17 mm Hg). Following DCH, cerebral oxygenation improved from a mean of 21.2 ± 13.8 mm Hg to 45.5 ± 25.4 mm Hg, a 114.8% increase. The change in brain tissue O2 and the change in ICP after DCH demonstrated only a modest relationship (r2 = 0.3). These results indicate that the use of DCH in the treatment of severe brain injury is associated with a significant improvement in brain O2.
Albanese J, , Leone M, & Alliez JR, et al: Decompressive craniectomy for severe traumatic brain injury: evaluation of the effects at one year. Crit Care Med 31:2535–2538, 2003 Albanese J, Leone M, Alliez JR, et al: Decompressive craniectomy for severe traumatic brain injury: evaluation of the effects at one year. Crit Care Med 31:2535–2538, 2003
Bullock R, , Chesnut RM, & Clifton G, et al: Guidelines for the Management of Severe Head Injury. Park Ridge, IL: American Association of Neurological Surgeons & the Brain Trauma Foundation, 1995 Bullock R, Chesnut RM, Clifton G, et al: Guidelines for the Management of Severe Head Injury. Park Ridge, IL: American Association of Neurological Surgeons & the Brain Trauma Foundation, 1995
Bullock R, , Zauner A, & Woodward JJ, et al: Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg 89:507–18, 1998 Bullock R, Zauner A, Woodward JJ, et al: Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg 89:507–18, 1998
Burnett MG, , Shabbar FD, & McKhann GM II, et al: Pathology and pathophysiology of aneurysmal subarachnoid hemorrhage, in Le Roux PD, , Winn HR, & Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 127–137 Burnett MG, Shabbar FD, McKhann GM II, et al: Pathology and pathophysiology of aneurysmal subarachnoid hemorrhage, in Le Roux PD, Winn HR, Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 127–137
Carmona Suazo JA, , Maas AI, & van den Brink WA, et al: CO2 reactivity and brain oxygen pressure monitoring in severe head injury. Crit Care Med 28:3268–3274, 2000 Carmona Suazo JA, Maas AI, van den Brink WA, et al: CO2 reactivity and brain oxygen pressure monitoring in severe head injury. Crit Care Med 28:3268–3274, 2000
Chesnut RM: Hyperventilation in traumatic brain injury: friend or foe? Crit Care Med 25:1275–1278, 1997 Chesnut RM: Hyperventilation in traumatic brain injury: friend or foe? Crit Care Med 25:1275–1278, 1997
Chestnut RM: Medical management of intracranial pressure, in Cooper PR, & Golfinos JG (eds): Head Injury, ed 4. New York: McGraw-Hill, 2000, pp 229–263 Chestnut RM: Medical management of intracranial pressure, in Cooper PR, Golfinos JG (eds): Head Injury, ed 4. New York: McGraw-Hill, 2000, pp 229–263
Clay HD: Validity and reliability of the SjvO2 catheter in neurologically impaired patients: a critical review of the literature. J Neurosci Nurs 32:194–203, 2000 Clay HD: Validity and reliability of the SjvO2 catheter in neurologically impaired patients: a critical review of the literature. J Neurosci Nurs 32:194–203, 2000
Coles JP, , Minhas PS, & Fryer TD, et al: Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med 30:1950–1959, 2002 Coles JP, Minhas PS, Fryer TD, et al: Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med 30:1950–1959, 2002
Coplin WM, , Cullen NK, & Policherla PN, et al: Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J Trauma 50:1050–1059, 2001 Coplin WM, Cullen NK, Policherla PN, et al: Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J Trauma 50:1050–1059, 2001
Cruz J: Adverse effects of pentobarbital on cerebral venous oxygenation of comatose patients with acute traumatic brain swelling: relationship to outcome. J Neurosurg 85:758–761, 1996 Cruz J: Adverse effects of pentobarbital on cerebral venous oxygenation of comatose patients with acute traumatic brain swelling: relationship to outcome. J Neurosurg 85:758–761, 1996
Cruz J: The first decade of continuous monitoring of jugular bulb oxyhemoglobinsaturation: management strategies and clinical outcome. Crit Care Med 26:344–351, 1998 Cruz J: The first decade of continuous monitoring of jugular bulb oxyhemoglobinsaturation: management strategies and clinical outcome. Crit Care Med 26:344–351, 1998
Dearden NM: Mechanisms and prevention of secondary brain damage during intensive care. Clin Neuropathol 17:221–228, 1998 Dearden NM: Mechanisms and prevention of secondary brain damage during intensive care. Clin Neuropathol 17:221–228, 1998
Dings J, , Meixensberger J, & Jager A, et al: Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. Neurosurgery 43:1082–1095, 1998 Dings J, Meixensberger J, Jager A, et al: Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. Neurosurgery 43:1082–1095, 1998
Filippi R, , Reisch R, & Mauer D, et al: Brain tissue pO2 related to SjvO2, ICP, and CPP in severe brain injury. Neurosurg Rev 23:94–97, 2000 Filippi R, Reisch R, Mauer D, et al: Brain tissue pO2 related to SjvO2, ICP, and CPP in severe brain injury. Neurosurg Rev 23:94–97, 2000
Forsting M, , Reith W, & Schabitz WR, et al: Decompressive craniectomy for cerebral infarction. An experimental study in rats. Stroke 26:259–264, 1995 Forsting M, Reith W, Schabitz WR, et al: Decompressive craniectomy for cerebral infarction. An experimental study in rats. Stroke 26:259–264, 1995
Frank JI: Large hemispheric infarction, deterioration, and intracranial pressure. Neurology 45:1286–1290, 1995 Frank JI: Large hemispheric infarction, deterioration, and intracranial pressure. Neurology 45:1286–1290, 1995
Gopinath SP, , Robertson CS, & Contant CF, et al: Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry 57:717–723, 1994 Gopinath SP, Robertson CS, Contant CF, et al: Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry 57:717–723, 1994
Gopinath SP, , Valadka AB, & Uzura M, et al: Comparison of jugular venous oxygen saturation and brain tissue PO2 as monitors of cerebral ischemia after head injury. Crit Care Med 27:2337–2345, 1999 Gopinath SP, Valadka AB, Uzura M, et al: Comparison of jugular venous oxygen saturation and brain tissue PO2 as monitors of cerebral ischemia after head injury. Crit Care Med 27:2337–2345, 1999
Gracias VH, , Guillamondegui OD, & Stiefel MF, et al: Cerebral cortical oxygenation: a pilot study. J Trauma 56:469–474, 2003 Gracias VH, Guillamondegui OD, Stiefel MF, et al: Cerebral cortical oxygenation: a pilot study. J Trauma 56:469–474, 2003
Guerra WK, , Gaab MR, & Dietz H, et al: Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 90:187–196, 1999 Guerra WK, Gaab MR, Dietz H, et al: Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 90:187–196, 1999
Gupta AK, , Hutchinson PJ, & Al-Rawi P, et al: Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 88:549–553, 1999 Gupta AK, Hutchinson PJ, Al-Rawi P, et al: Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 88:549–553, 1999
Hayes C, , Robertson CS, & Narayan RK, et al: The effect of hyperventilation on cerebral blood flow in head injured patients. American Association of Neurological Surgeons:1271, 1992 (Abstract) Hayes C, Robertson CS, Narayan RK, et al: The effect of hyperventilation on cerebral blood flow in head injured patients. American Association of Neurological Surgeons: 1271, 1992 (Abstract)
Heuer GC, , Smith MJ, & Elliott JP, et al: The relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg (In press, 2004) Heuer GC, Smith MJ, Elliott JP, et al: The relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg (In press, 2004)
Hoffman WE, , Charbel FT, & Gonzalez-Portillo G, et al: Measurement of ischemia by changes in tissue oxygen, carbon dioxide, and pH. Surg Neurol 51:654–658, 1999 Hoffman WE, Charbel FT, Gonzalez-Portillo G, et al: Measurement of ischemia by changes in tissue oxygen, carbon dioxide, and pH. Surg Neurol 51:654–658, 1999
Hovda DA, , Lee SM, & Smith ML, et al: The neurochemical and metabolic cascade following brain injury: moving from animal models to man. J Neurotrauma 12:903–906, 1995 Hovda DA, Lee SM, Smith ML, et al: The neurochemical and metabolic cascade following brain injury: moving from animal models to man. J Neurotrauma 12:903–906, 1995
Jaeger M, , Soehle M, & Meixensberger J: Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatry 74:513–515, 2003 Jaeger M, Soehle M, Meixensberger J: Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatry 74:513–515, 2003
Jiang J, , Yu M, & Zhu C: Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. J Neurosurg 93:546–549, 2000 Jiang J, Yu M, Zhu C: Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. J Neurosurg 93:546–549, 2000
Kaufmann AM, & Cardoso ER: Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg 77:584–589, 1992 Kaufmann AM, Cardoso ER: Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg 77:584–589, 1992
Kelly DF, , Kordestani RK, & Martin NA, et al: Hyperemia following traumatic brain injury: relationship to intracranial hypertension and outcome. J Neurosurg 85:762–771, 1996 Kelly DF, Kordestani RK, Martin NA, et al: Hyperemia following traumatic brain injury: relationship to intracranial hypertension and outcome. J Neurosurg 85:762–771, 1996
Kett-White R, , Hutchinson PJ, & Al-Rawi PG, et al: Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery 50:1213–1222, 2002 Kett-White R, Hutchinson PJ, Al-Rawi PG, et al: Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery 50:1213–1222, 2002
Kiening KL, , Hartl R, & Unterberg AW et al: Brain tissue pO2-monitoring in comatose patients: implications for therapy. Neurol Res 19:233–240, 1997 Kiening KL, Hartl R, Unterberg AW, et al: Brain tissue pO2-monitoring in comatose patients: implications for therapy. Neurol Res 19:233–240, 1997
Kondziolka D, & Fazl M: Functional recovery after decompressive craniectomy for cerebral infarction. Neurosurgery 23:143–147, 1988 Kondziolka D, Fazl M: Functional recovery after decompressive craniectomy for cerebral infarction. Neurosurgery 23:143–147, 1988
Lee JH, , Kelly DF, & Oertel M, et al: Carbon dioxide reactivity, pressure autoregulation, and metabolic suppression reactivity after head injury: a transcranial Doppler study. J Neurosurg 95:222–232, 2001 Lee JH, Kelly DF, Oertel M, et al: Carbon dioxide reactivity, pressure autoregulation, and metabolic suppression reactivity after head injury: a transcranial Doppler study. J Neurosurg 95:222–232, 2001
Lee JH, , Martin NA, & Alsina G, et al: Hemodynamically significant cerebral vasospasm and outcome after head injury: a prospective study. J Neurosurg 87:221–233, 1997 Lee JH, Martin NA, Alsina G, et al: Hemodynamically significant cerebral vasospasm and outcome after head injury: a prospective study. J Neurosurg 87:221–233, 1997
Le Roux PD, , Newell DW, & Lam AM, et al: Cerebral arteriovenous oxygen difference: a predictor of cerebral infarction and outcome in patients with severe head injury. J Neurosurg 87:1–8, 1997 Le Roux PD, Newell DW, Lam AM, et al: Cerebral arteriovenous oxygen difference: a predictor of cerebral infarction and outcome in patients with severe head injury. J Neurosurg 87:1–8, 1997
Le Roux PD, & Winn HR: Management of the ruptured aneurysm, in Le Roux PD, , Winn HR, & Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 303–333 Le Roux PD, Winn HR: Management of the ruptured aneurysm, in Le Roux PD, Winn HR, Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 303–333
Maas AI, , Fleckenstein W, & de Jong DA et al: Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue oxygen tension. Acta Neurochir Suppl 59:50–57, 1993 Maas AI, Fleckenstein W, de Jong DA, et al: Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue oxygen tension. Acta Neurochir Suppl 59:50–57, 1993
Maloney-Wilensky E, , FitzPatrick MK, & Sicoutris C, et al: A multidisciplinary team approach to implementation of new clinical technology: brain tissue oxygenation multi-modality monitoring system. J Trauma Nurs 9:96–102 2002 Maloney-Wilensky E, FitzPatrick MK, Sicoutris C, et al: A multidisciplinary team approach to implementation of new clinical technology: brain tissue oxygenation multi-modality monitoring system. J Trauma Nurs 9:96–102 2002
Marshall LF, , Smith RW, & Rauscher LA, et al: Mannitol dose requirements in brain-injured patients. J Neurosurg 48:169–172, 1978 Marshall LF, Smith RW, Rauscher LA, et al: Mannitol dose requirements in brain-injured patients. J Neurosurg 48:169–172, 1978
Marshall LF, , Smith RW, & Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part I: the significance of intracranial pressure monitoring. J Neurosurg 50:20–25, 1979 Marshall LF, Smith RW, Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part I: the significance of intracranial pressure monitoring. J Neurosurg 50:20–25, 1979
Max AR: Guidelines for the management of severe head injury, in Vincent JL (ed): Yearbook of Intensive Care and Emergency Medicine. Berlin: Springer-Verlag, 1996, pp 707–715 Max AR: Guidelines for the management of severe head injury, in Vincent JL (ed): Yearbook of Intensive Care and Emergency Medicine. Berlin: Springer-Verlag, 1996, pp 707–715
McKhann GM II, , Mayer SA, & Le Roux PD: Perioperative and intensive care of patients with aneurysmal subarachnoid hemorrhage, in Le Roux PD, , Winn HR, & Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 431–454 McKhann GM II, Mayer SA, Le Roux PD: Perioperative and intensive care of patients with aneurysmal subarachnoid hemorrhage, in Le Roux PD, Winn HR, Newell DW (eds): Management of Cerebral Aneurysms. Philadelphia: Elsevier Science, 2004, pp 431–454
Meixensberger J, , Vath A, & Jaeger M, et al: Monitoring of brain tissue oxygenation following severe subarachnoid hemorrhage. Neurol Res 25:445–450, 2003 Meixensberger J, Vath A, Jaeger M, et al: Monitoring of brain tissue oxygenation following severe subarachnoid hemorrhage. Neurol Res 25:445–450, 2003
Mendelow AD, , Teasdale GM, & Russell T, et al: Effect of mannitol on cerebral blood flow and cerebral perfusion pressure in human head injury. J Neurosurg 63:43–48, 1985 Mendelow AD, Teasdale GM, Russell T, et al: Effect of mannitol on cerebral blood flow and cerebral perfusion pressure in human head injury. J Neurosurg 63:43–48, 1985
Menzel M, , Doppenberg EM, & Zauner A, et al: Cerebral oxygenation in patients after severe head injury: monitoring and effects of arterial hyperoxia on cerebral blood flow, metabolism and intracranial pressure. J Neurosurg Anesthesiol 11:240–251, 1999 Menzel M, Doppenberg EM, Zauner A, et al: Cerebral oxygenation in patients after severe head injury: monitoring and effects of arterial hyperoxia on cerebral blood flow, metabolism and intracranial pressure. J Neurosurg Anesthesiol 11:240–251, 1999
Miller JD, , Butterworth JF, & Gudeman SK, et al: Further experience in the management of severe head injury. J Neurosurg 54:289–299, 1981 Miller JD, Butterworth JF, Gudeman SK, et al: Further experience in the management of severe head injury. J Neurosurg 54:289–299, 1981
Muizelaar JP, , Marmarou A, & Ward JD, et al: Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 75:731–739, 1991 Muizelaar JP, Marmarou A, Ward JD, et al: Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 75:731–739, 1991
Munch E, , Horn P, & Schurer L, et al: Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 47:315–323, 2000 Munch E, Horn P, Schurer L, et al: Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 47:315–323, 2000
Narayan RK, , Kishore PR, & Becker DP, et al: Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 56:650–659, 1982 Narayan RK, Kishore PR, Becker DP, et al: Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 56:650–659, 1982
Obrist WD, , Langfitt TW, & Jaggi JL, et al: Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61:241–253, 1984 Obrist WD, Langfitt TW, Jaggi JL, et al: Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61:241–253, 1984
Piek J: Decompressive surgery in the treatment of traumatic brain injury. Curr Opin Crit Care 8:134–138, 2002 Piek J: Decompressive surgery in the treatment of traumatic brain injury. Curr Opin Crit Care 8:134–138, 2002
Polin RS, , Shaffrey ME, & Bogaev CA, et al: Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41:84–94, 1997 Polin RS, Shaffrey ME, Bogaev CA, et al: Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41:84–94, 1997
Procaccio F, , Stocchetti N, & Citerio G, et al: Guidelines for the treatment of adults with severe head trauma (part II). Criteria for medical treatment. J Neurosurg Sci 44:11–18, 2000 Procaccio F, Stocchetti N, Citerio G, et al: Guidelines for the treatment of adults with severe head trauma (part II). Criteria for medical treatment. J Neurosurg Sci 44:11–18, 2000
Rengachary SS, , Batnitzky S, & Morantz RA, et al: Hemicraniectomy for acute massive cerebral infarction. Neurosurgery 8:321–328, 1981 Rengachary SS, Batnitzky S, Morantz RA, et al: Hemicraniectomy for acute massive cerebral infarction. Neurosurgery 8:321–328, 1981
Rieke K, , Krieger D, & Adams HP, et al: Therapeutic strategies in space-occupying cerebellar infarction based on clinical, neuroradiological and neurophysiological data. Cerebrovasc Dis 3:45–55, 1993 Rieke K, Krieger D, Adams HP, et al: Therapeutic strategies in space-occupying cerebellar infarction based on clinical, neuroradiological and neurophysiological data. Cerebrovasc Dis 3:45–55, 1993
Robertson C: Critical care management of traumatic brain injury, in Winn HR (ed): Youmans Neurological Surgery, ed 5. Philadelphia: W B Saunders, 2004, pp 5103–5144 Robertson C: Critical care management of traumatic brain injury, in Winn HR (ed): Youmans Neurological Surgery, ed 5. Philadelphia: W B Saunders, 2004, pp 5103–5144
Robertson CS, , Narayan RK, & Gokaslan ZL, et al: Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 70:222–230, 1989 Robertson CS, Narayan RK, Gokaslan ZL, et al: Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 70:222–230, 1989
Rosner MJ, , Rosner SD, & Johnson AH: Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83:949–962, 1995 Rosner MJ, Rosner SD, Johnson AH: Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83:949–962, 1995
Sarrafzadeh AS, , Kiening KL, & Callsen TA, et al: Metabolic changes during impending and manifest cerebral hypoxia in traumatic brain injury. Br J Neurosurg 17:340–346, 2003 Sarrafzadeh AS, Kiening KL, Callsen TA, et al: Metabolic changes during impending and manifest cerebral hypoxia in traumatic brain injury. Br J Neurosurg 17:340–346, 2003
Sarrafzadeh AS, , Sakowitz OW, & Callsen TA, et al: Detection of secondary insults by brain tissue pO2 and bedside microdialysis in severe head injury. Acta Neurochir Suppl 81:319–321, 2002 Sarrafzadeh AS, Sakowitz OW, Callsen TA, et al: Detection of secondary insults by brain tissue pO2 and bedside microdialysis in severe head injury. Acta Neurochir Suppl 81:319–321, 2002
Schroder ML, , Muizelaar JP, & Bullock MR, et al: Focal ischemia due to traumatic contusions documented by stable xenon-CT and ultrastructural studies. J Neurosurg 82:966–971, 1995 Schroder ML, Muizelaar JP, Bullock MR, et al: Focal ischemia due to traumatic contusions documented by stable xenon-CT and ultrastructural studies. J Neurosurg 82:966–971, 1995
Schwab S, , Spranger M, & Schwarz S, et al: Barbiturate coma in severe hemispheric stroke: useful or obsolete? Neurology 48:1608–1613, 1997 Schwab S, Spranger M, Schwarz S, et al: Barbiturate coma in severe hemispheric stroke: useful or obsolete? Neurology 48:1608–1613, 1997
Schwab S, , Steiner T, & Aschoff A, et al: Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29:1888–1893, 1998 Schwab S, Steiner T, Aschoff A, et al: Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29:1888–1893, 1998
Sheinberg M, , Kanter MJ, & Robertson CS, et al: Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J Neurosurg 76:212–217, 1992 Sheinberg M, Kanter MJ, Robertson CS, et al: Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J Neurosurg 76:212–217, 1992
Smith ER, , Carter BS, & Ogilvy CS: Proposed use of prophylactic decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage patients presenting with associated large Sylvian hematomas. Neurosurgery 51:117–124, 2002 Smith ER, Carter BS, Ogilvy CS: Proposed use of prophylactic decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage patients presenting with associated large Sylvian hematomas. Neurosurgery 51:117–124, 2002
Stocchetti N, , Paparella A, & Bridelli F, et al: Cerebral venous oxygen saturation studied using bilateral samples in the jugular veins. Neurosurgery 34:38–44, 1994 Stocchetti N, Paparella A, Bridelli F, et al: Cerebral venous oxygen saturation studied using bilateral samples in the jugular veins. Neurosurgery 34:38–44, 1994
Teasdale G, & Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84, 1974 Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84, 1974
Umezawa H, , Shima K, & Chigasaki H, et al: Local cerebral blood flow and glucose metabolism in hydrostatic brain oedema. Acta Neurochir Suppl 51:351–353, 1990 Umezawa H, Shima K, Chigasaki H, et al: Local cerebral blood flow and glucose metabolism in hydrostatic brain oedema. Acta Neurochir Suppl 51:351–353, 1990
Valadka AB, , Gopinath SP, & Contant CF, et al: Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med 26:1576–1581, 1998 Valadka AB, Gopinath SP, Contant CF, et al: Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med 26:1576–1581, 1998
van den Brink WA, , van Santbrink H, & Steyerberg EW, et al: Brain oxygen tension in severe head injury. Neurosurgery 46:868–878, 2000 van den Brink WA, van Santbrink H, Steyerberg EW, et al: Brain oxygen tension in severe head injury. Neurosurgery 46:868–878, 2000
van Santbrink H, , Maas AI, & Avezaat CJ: Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 38:21–31, 1996 van Santbrink H, Maas AI, Avezaat CJ: Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 38:21–31, 1996
van Santbrink H, , vd Brink WA, & Steyerberg EW, et al: Brain tissue oxygen response in severe traumatic brain injury. Acta Neurochir 145:429–438, 2003 van Santbrink H, vd Brink WA, Steyerberg EW, et al: Brain tissue oxygen response in severe traumatic brain injury. Acta Neurochir 145:429–438, 2003
Yundt KD, , Grubb RL Jr, & Diringer MN, et al: Autoregulatory vasodilation of parenchymal vessels is impaired during cerebral vasospasm. J Cereb Blood Flow Metab 18:419–424, 1998 Yundt KD, Grubb RL Jr, Diringer MN, et al: Autoregulatory vasodilation of parenchymal vessels is impaired during cerebral vasospasm. J Cereb Blood Flow Metab 18:419–424, 1998
Zauner A, , Bullock R, & Di X, et al: Brain oxygen, CO2, pH, and temperature monitoring: evaluation in the feline brain. Neurosurgery 37:1168–1177, 1995 Zauner A, Bullock R, Di X, et al: Brain oxygen, CO2, pH, and temperature monitoring: evaluation in the feline brain. Neurosurgery 37:1168–1177, 1995
Zauner A, , Daugherty WP, & Bullock MR, et al: Brain oxygenation and energy metabolism: part I—biological function and pathophysiology. Neurosurgery 51:289–302, 2002 Zauner A, Daugherty WP, Bullock MR, et al: Brain oxygenation and energy metabolism: part I—biological function and pathophysiology. Neurosurgery 51:289–302, 2002
Zauner A, , Doppenberg E, & Woodward JJ, et al: Multiparametric continuous monitoring of brain metabolism and substrate delivery in neurosurgical patients. Neurol Res 19:265–273, 1997 Zauner A, Doppenberg E, Woodward JJ, et al: Multiparametric continuous monitoring of brain metabolism and substrate delivery in neurosurgical patients. Neurol Res 19:265–273, 1997
Zauner A, , Doppenberg EM, & Woodward JJ, et al: Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 41:1082–1093, 1997 Zauner A, Doppenberg EM, Woodward JJ, et al: Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 41:1082–1093, 1997
Ziai WC, , Port JD, & Cowan JA, et al: Decompressive craniectomy for intractable cerebral edema: experience of a single center. J Neurosurg Anesthesiol 15:25–32, 2003 Ziai WC, Port JD, Cowan JA, et al: Decompressive craniectomy for intractable cerebral edema: experience of a single center. J Neurosurg Anesthesiol 15:25–32, 2003
| All Time | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 739 | 272 | 16 |
| Full Text Views | 256 | 43 | 1 |
| PDF Downloads | 155 | 37 | 1 |
| EPUB Downloads | 0 | 0 | 0 |