Successful management of severe intracranial hypertension by surgical decompression

Because of the rather disappointing results in the treatment of acute head‐injury in adults, surgical decompression has been little used in the management of severe intracranial hypertension. The authors report the successful use of the technique for a child with encephalitis in whom cerebral perfusion was compromised. Traitement efficace de l'hypertension intracranienne majeure par décompression chirurgicale En raison des résultats décevants dans le traitement des traumatismes céphaliques aigus chez l'adulte, la décompression chirurgicale a été peu utilisée dans le traitement de l'hypertension intracranienne majeure. Les auteurs rapportent l'utilisation efficace de la technique chez un enfant porteur d'encéphalite don't l'irrigation cérébrale était compromise. Erfolgreiche Behandlung eines schweren intrakraniellen Hochdrucks durch chirurgische Dekompression Wegen der relativ enttäuschenden Ergebnisse bei der Behandlung akuter Kopfverletzungen bei Erwachsenen ist die chirurgische Dekompression bei schwerem intrakraniellem Hochdruck selten durchgeführt worden. Die Autoren berichten über die erfolgreiche Anwendung dieser Methode bei einem Kind mit Enzephalitis, bei dem die cerebrale Perfusion gefährdet war. Tratamiento con éxito de la hipertensión endocraneana severa por descompresión quirúrgica Debido a los resultados más bien decepcionantes obtenidos en la lesión craneal aguda en adultos, la descompresión quirúrgica se ha usado poco en el tratamiento de la hipertensiön intracraneal aguda grave. Los autorea aportan !a utilizatión con éxito de la técnica en un niño con encefalitis en que la perfusión cerebral estaba comprometida.</p

Anatomical validation of middle cerebral artery position as identified by transcranial pulsed Doppler ultrasound

The basal cerebral arteries were insonated using transcranial pulsed Doppler ultrasound (TPDU) at 2 MHz. The Doppler sample volume (SV) depths at which signals were obtained which could be attributed to the middle, anterior and posterior cerebral arteries (MCA, ACA and PCA) were compared with measurements in adult cadavers and with B-scan ultrasound studies in infants. The depth of the internal carotid artery (ICA) terminal division into ACA and MCA was closely correlated for both groups. In adults, it was found at 5-6 ± 10 cm using TPDU while in cadavers it was found at 5 3 ± 05 cm from the temporal bone. In infants, it was found at 3-2 ± 03 cm for the right side, and 3-2 ± 0-2 cm for the left side using TPDU, and at 3-4 ± 04 cm and 3-4 ± O 5 cm for right and left sides respectively using B-scan ultrasound. The mean depth of the MCA mid-point in infants as defined by TPDU and B-scan was also closely correlated, with values of 2-8 ± 03 cm and 2-7 ± 03 cm for right and left sides respectively using TPDU and of 2-8 ± 04 cm and 2-7 ± 04 cm for right and left sides respectively using B-scan ultrasound. Values for the most lateral part of the MCA did not correlate. In adults, signals from the ACA and PCA were obtained at greater SV depth than the MCA, thus preventing confusion.</p