Experience of Intracranial Pressure Monitoring in Patients after Glial TumorResection Following Mass Effect and Dislocation Syndrome
Patient N., aged 62, with the diagnosis left mediobasal fronto-temporal lobe tumor was electively hospitalized in the Hospital of Emergency care. The patient’s condition at the time of admission was moderate; level of consciousness was 14 points by the Glasgow Coma Scale (GCS); the patient complaints of mild headache, weakness in the right extremities. MRI revealed glial formation with large perifocal edema offset medial structures 7 mm. The total removal of the tumor under endotracheal anesthesia with complete muscle relaxation was electively performed. There was a significant intraoperative brain edema with large prolapse of the brain tissues. Antiedematous therapy used, increased head position at 45º were not effective enough. Given the above situation, during the operation in the subdural space PVC catheter was administered to measure and correct intracranial pressure (ICP). Postoperatively, the patient was transferred to the intensive care unit, where mechanical ventilation was prolonged in normoventilation mode (respirator iVent, Israel) and intensive care was conducted under the protocol, the vital parameters were appropriately monitored, and ICP started to be measured. ICP was monitored carried by multifunctional monitor IntelliVue Patient Monitor MP40 (Philips) of the line for invasive pressure measurement by subdural fluid-filled catheter with an external transducer reusable connectep. The patient received intensive therapy according to the current protocol, artificial ventilation, enteral nutritional support with energy value of 35 kcal/kg, antibiotic prophylaxis, prevention of thromboembolic complications, stress damage to the gastrointestinal tract, analgosedation and adaptation to mechanical ventilation (sodium hydroxybutyrate, morphine, diazepam, thiopental). If ICP increased appropriate treatment with hyperosmotic solutions (mannitol, hypertonic sodium chloride), dexamethasone and solu-medrol was performed. While patient’s treatment her consciousness recovered to the level up to 13 points by GCS. On the second day of treatment the level of consciousness of the patient was 14 points by GCS. On the third day the condition improved, the level of consciousness was 14 points by GCS, the patient was transferred to the neurosurgical department. On the tenth day the patient underwent re-operation for closing the bone flaw. The patient was discharged home in good condition, with no neurological deficit deepening. Complications associated with ICP monitoring were not determined. Conclusions. The method of ICP monitoring via subdural sensor with a standard multifunctional display is a robust, reliable, affordable and economically feasible. Implementation of ICP monitoring requires close collaboration between neurosurgeons and anesthesiologists. ICP monitoring in patients with brain tumors in the early postoperative period had a significant impact on the therapy in these patients. ICP measurement in the early postoperative period makes it possible to control edema of the brain and impact the proper selection of the therapy without traumatic transporting the patient for CT examination of the brain.