A Study of Influencing Factors of Intracranial Pressure and Prognosis with Continuous Intracranial Pressure Monitoring in Severe Inreacranial Lesions.

Ko, Sam Kyu; Ihm, Jowa Hyuk; Choi, Yong Cheol; Moon, Choong Bae; Choi, Byung Yearn; Cho, Soo Ho

Original Article

Journal of Korean Neurosurgical Society 1987;16(2): 411-424.

Sam Kyu Ko, Jowa Hyuk Ihm, Yong Cheol Choi, Choong Bae Moon, Byung Yearn Choi, Soo Ho Cho

Department of Neurosurgery, College of Medicine, Yeungnam University, Taegu, Korea.

ABSTRACT

The cranium can be thought of a as shallow, rigid sphere of contrast volume. There are three main components within the intracranial space : brain, cerebrospinal fluid and blood. Intracranial volume and pressure are maintained constantly by Monroe-Kellie doctrine. Also intracranial pressure is influenced by a number of physiologic factors and it will be changed with intracranial lesion. Now we were look for the possible factors that influence the intracranial pressure with continuous intracranial pressure monitoring. At the same time we studied the possibility of the relationship between factors that influence ICP and ADL(Ability of Daily Life) in 43 severe brain lesions(33 cases ; intracerebral hematoma, 10 cases ; head injury). In cases of higher GCS, smaller hematoma, lower amplitude of ICP, lesser frequency of A-wave and lower elastance, the ICP were lowed. Ninety percent of cases that GCS is over 12 was belong to ADL I and II, but only nineteen percent of cases that GCS is under 7 was belong to ADL I and II. No case of internal capsule involved group was belong to ADL I but forty-eight percent of cases whose hematoma volume is under 10ml was belong to ADL I. Fifty percent of cases whose hematoma volume is under 10ml was belong to ADL I and no case that hematoma volume is over 20ml was belong to ADL I. Cases that PCO2 is in the range of 25mmHg-29mmHg were not belong to ADL I. In cases of higher amplitude of ICP, higher frequency of A-wave and higher elastance, the patient's ADL was grave. And in cases of ICP was progressively increased, the prognosis was also grave. Consequently we are able to guess that patient's prognosis will be influenced by initial GCS, internal capsule involvement, hematoma volume, PCO2, amplitude of ICP, frequency of A-Wave, brain elastance and curve of ICP.

Key Words: Monroe-Kellie doctrine; Continuous intracranial pressure monitoring; Ability of daily life