Intracranial pressure monitoring alone: Not an absolutely reliable tool after decompressive craniectomy for traumatic acute subdural hematoma

Introduction: The monitoring of intracranial pressure (ICP) in traumatic brain injury (TBI) is important for postoperative care. In our clinical practice, we have found that neurological deterioration because of contralateral epidural hematoma (EDH) occurs despite normal ICP in patients who have undergone decompressive craniectomy (DC). This study was performed to elucidate the dilemmas associated with ICP monitoring after DC and the possible complementary role of intraoperative and immediate postoperative imaging studies. Methods: Patients who had received DC due to TBI during a 7-year period were retrospectively identified from our database and evaluated. Logistic regression analyses were used to evaluate the associations between patients. Results: Twenty patients had contralateral skull fractures. Five patients (5 of 10, 50%) who developed EDH on the ipsilateral side of the skull fracture underwent operations for EDH evacuation due to the deterioration of their clinical condition. The ICP was significantly lower (P = 0.016) in these patients compared with patients who did not undergo secondary surgery due to EDH. Conclusions: ICP monitoring alone cannot absolutely ensure early detection of contralateral space-occupying lesion after DC due to improvement in cerebral compliance. Imaging studies using brain computed tomography is beneficial for early detection of delayed EDH after DC in a high-risk skull fracture with contralateral acute subdural hematoma patients

Ruptured infective intracranial aneurysm with intracerebral hemorrhage in an infant

Intracranial aneurysms are rare in children. Less than 10% of pediatric intracranial aneurysms are infective aneurysms, and few cases of such aneurysms in infants have been reported in the literature. In this study, we report the case of a 1-month-old preterm infant presenting with recurrent intracerebral hemorrhage due to a ruptured intracranial infective aneurysm. Blood culture yielded Candida species. Brain computed tomography and cerebral angiography revealed a large intracerebral hematoma in the left frontal lobe and a 2.7-mm sized aneurysm in a distal branch of the middle cerebral artery. The patient underwent craniotomy for hematoma evacuation and aneurysm excision. After the surgical intervention, antifungal therapy, and rehabilitation treatment, the patient recovered with mild neurological sequelae. This case demonstrated that the aggressive treatment for infective intracranial aneurysm is key to a favorable outcome, even in a young infant