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Corticosteroid treatment for refractory intracranial hypertension: a rescue therapy in patients with severe traumatic brain injury with contusional lesions-a feedback.
Menat, Sophie; Jacquens, Alice; Mathon, Bertrand; Bonnet, Baptiste; Schotar, Eimad; Boch, Anne-Laure; Carpentier, Alexandre; Puybasset, Louis; Abdennour, Lamine; Degos, Vincent.
Affiliation
  • Menat S; Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France.
  • Jacquens A; Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France. alice.jacquens@gmail.com.
  • Mathon B; Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
  • Bonnet B; Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
  • Schotar E; Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
  • Boch AL; Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
  • Carpentier A; Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
  • Puybasset L; Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
  • Abdennour L; Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France.
  • Degos V; Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
Acta Neurochir (Wien) ; 165(3): 717-725, 2023 03.
Article in En | MEDLINE | ID: mdl-36808006
INTRODUCTION: Refractory intracranial hypertension (rICH) is a severe complication among patients with severe traumatic brain injury (sTBI). Medical treatment may be insufficient, and in some cases, the only viable treatment option is decompressive hemicraniectomy. The assessment of a corticosteroid therapy against vasogenic edema secondary to severe brain injuries seems interesting to prevent this surgery in sTBI patients with rICH caused by contusional areas. METHODS: This is a monocentric retrospective observational study including all consecutive sTBI patients with contusion injuries and a rICH requiring cerebrospinal fluid drainage with external ventricular drainage between November 2013 and January 2018. Patient inclusion criterium was a therapeutic index load (TIL; an indirect measure of TBI severity) > 7. Intracranial pressure (ICP) and TIL were assessed before and 48 h after corticosteroid therapy (CTC). Then, we divided the population into two groups according to the evolution of the TIL: responders and non-responders to corticosteroid therapy. RESULTS: During the study period, 512 patients were hospitalized for sTBI, and among them, 44 (8.6%) with rICH were included. They received 240 mg per day [120 mg, 240 mg] of Solu-Medrol for 2 days [1; 3], 3 days after the sTBI. The average ICP in patients with rICH before the CTC bolus was 21 mmHg [19; 23]. After the CTC bolus, the ICP fell significantly to less than 15 mmHg (p < 0.0001) for at least 7 days. The TIL decreased significantly the day after the CTC bolus and until day 2. Among these 44 patients, 68% were included in the responder group (n = 30). DISCUSSION: Short and systemic corticosteroid therapy in patients with refractory intracranial hypertension secondary to severe traumatic brain injury seems to be a potentially useful and efficient treatment for lowering intracranial pressure and decreasing the need for more invasive surgeries.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Injuries / Contusions / Intracranial Hypertension / Brain Injuries, Traumatic Type of study: Etiology_studies / Observational_studies Limits: Humans Language: En Journal: Acta Neurochir (Wien) Year: 2023 Document type: Article Affiliation country: France Country of publication: Austria

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Injuries / Contusions / Intracranial Hypertension / Brain Injuries, Traumatic Type of study: Etiology_studies / Observational_studies Limits: Humans Language: En Journal: Acta Neurochir (Wien) Year: 2023 Document type: Article Affiliation country: France Country of publication: Austria