CT环池分级结合颅内压监测在去骨瓣减压术后的应用

目的研究CT环池分级结合持续颅内压监测在重型颅脑创伤患者行单侧去骨瓣减压术后的应用。方法对19例去骨瓣减压术并行颅内压监测的患者,记录颅内压值(ICP)和头颅CT环池分级(Ⅰ级:环池完全闭塞;Ⅱ级:0.1~1.0 mm;Ⅲ级:1.0~2.0 mm);并行术后3个月GOS预后评分,5分、4分归为恢复良好,评分3分、2分、1分为预后不良;对这些因素行统计学分析。结果去骨瓣减压术后环池分级与ICP存在负相关性,环池分级越低,ICP越高,差异具有统计学意义。环池分级、颅内压与预后存在相关性,术后ICP24 h水平与患者预后相关性最强。恢复不良组的ICP值(43.60±17.92)mm Hg明显高于恢复良好组(14.18±6.62)mm Hg,差异有统计学意义(P0.05)。结论评估去骨瓣减压术患者预后,ICP监测优于环池分级,术后ICP24 h与预后存在负相关;去骨瓣减压术后环池分级可反应ICP水平;运用ICP监测,可指导治疗和评估预后。     

TCD两种参数预估去骨瓣减压术后颅内压的准确度分析

目的对比评价经颅多普勒超声(TCD)中基于搏动指数(PI)评估颅内压(nICP_PI)和基于舒张期脑血流流速(FVd)评估颅内压(nICP_FVd)两种参数的准确度。方法回顾性分析44例行去骨瓣减压术患者的一般临床资料及TCD相关参数(55条记录)。结果把每一条TCD记录作为一个独立事件,nICP_FVd显示了与有创颅内压(ICP)更好的相关性与评估能力:r=0.61,P0.05;偏倚为-2.20 mmHg,95%预测置信区间(CI)=(-23.1 mmHg,18.7 mmHg);曲线下面积(AUC)=0.73,P0.05。而nICP_PI则与有创ICP无明显相关性:r=0.1,P0.05;偏倚为2.10 mmHg,95%CI=(-16.0 mmHg,20.1 mmHg);AUC=0.53,P0.05。结论去骨瓣减压术后基于TCD的参数nICP_FVd与参数nICP_PI相比较,前者能更准确地评估患者颅内压变化,具有更为可靠的参考价值。     

TCD对重度颅脑损伤去骨瓣减压术围手术期血流动力学监测的意义

目的探讨应用经颅多普勒(TCD)监测重度颅脑损伤患者开颅去骨瓣减压手术前、后的血流动力学变化,及其与患者预后的关系。方法对2015年4月至2017年4月收治的86例重度颅脑损伤(格拉斯哥昏迷量表评分8分)患者,行开颅去骨瓣减压术治疗;并在术前和术后应用TCD检测患者双侧大脑中动脉(MCA)及颈内动脉颅外段(ICAex)的血流动力学参数。结果与术前相比,术后患者双侧MCA及ICAex平均流速(Vm)明显增快(均P0.05),且手术侧血管Vm增快更为显著。与术前相比,搏动指数(PI)术后明显降低,其中手术侧降低更显著(均P0.05)。频谱形态术后转为高血流低阻力型。结论 TCD能很好地显示重度颅脑损伤患者开颅去骨瓣减压术围手术期血流动力学的改变,并对预后判断亦有重要意义。     

去骨瓣减压治疗重型颅脑损伤术中ICP的动态变化

目的探讨去骨瓣减压术(DC)治疗重型颅脑损伤中颅内压(ICP)的动态变化,分析减压前ICP与预后的相关性。方法回顾性分析35例重型颅脑损伤病人的临床资料,给予ICP探头植入后再行DC治疗。测定减压术前、去除骨瓣后、硬脑膜切开后、硬脑膜减张缝合后和关颅后的ICP,并于术后持续监测。出院时和伤后6个月以格拉斯哥预后评分(GOS)评估病人的预后,并分析减压术前ICP与预后的相关性。结果减压术前、骨瓣去除后、硬脑膜切开后、硬脑膜减张缝合后和关颅后的平均ICP分别为(42±12)mmHg、(26±6)mmHg、(6±3)mmHg、(8±5)mmHg和(12±7)mmHg。与减压术前相比较,骨瓣去除后和硬脑膜切开后ICP均明显下降(均P<0.001)。减压前ICP<40 mmHg组和ICP≥40 mmHg组在出院时和伤后6个月的预后良好率无显著差异(均P>0.05)。结论 DC治疗重型颅脑损伤时,硬脑膜广泛切开才能获得最大程度的ICP降低。     

改良CT计分结合持续颅内压监测在重型颅脑损伤去骨瓣减压术中的临床应用

目的探讨改良Rotterdam CT计分(改良CT计分)结合持续颅内压(ICP)监测在重型颅脑创伤患者行单侧去骨瓣减压术中的应用价值。方法回顾分析2015年1月~2016年1月期间收治的16例重型颅脑损伤去骨瓣减压术患者的临床资料;分析改良CT计分及持续ICP监测与术后6个月时格拉斯哥预后量表(Glasgow outcome scale,GOS)评分之间的关系。结果本组患者中预后良好者(GOS 4~5分)7例,预后不良者(GOS 1~3分)9例。两组不同预后患者在改良CT计分(术前)、ICP(初始,关颅,术后24 h)之间的差异均有统计学意义;评估去骨瓣减压术患者预后,改良CT计分可反映ICP水平,ICP优于改良CT计分,ICP与预后存在负相关。结论改良CT计分和持续ICP监测在去骨瓣减压术患者中有助于及时发现问题,可指导治疗和评估预后,二者具有重要的临床应用价值。     

急性双侧大脑半球弥漫性脑肿胀患者颅内压监测及意义

目的 探讨有创颅内压(ICP)监测对治疗创伤性急性双侧半球弥漫性脑肿胀的指导作用以及判断预后的意义.方法 2010年2月至2011年10月湖州市解放军第98医院神经外科在有创ICP监测下治疗创伤性急性双侧半球弥漫性脑肿胀59例,前瞻性研究患者入院时ICP、去骨瓣减压患者术前ICP和术后ICP等临床资料,按伤后6个月的GOS评分分为恢复良好组(GOS4 ～5分)和恢复不良组(GOS 1 ～3分).探讨入院时ICP、去骨瓣减压患者术前ICP、术后ICP与预后的关系.结果 本组病例恢复良好率69％ (41/59),恢复不良率31％ (18/59),病死率15％ (9/59).入院时GCS≥9分的患者预后无死亡及植物生存,入院时GCS 13～14分的患者均恢复工作或学习(GOS5分).在持续有创ICP监测下29例施行了去骨瓣减压术.入院时ICP、去骨瓣减压患者术前ICP和术后ICP恢复良好组分别是(22.2 ±7.9)mm Hg、(31.9±9.5)mm Hg和(12.3 ±2.9)mm Hg；恢复不良组分别是(33.4±18.9) mm Hg、(43.7±14.6)mm Hg和(13.0±5.6) mm Hg.两组指标相对应比较,患者入院时ICP、去骨瓣减压患者术前ICP差异有统计学意义(P＜0.05),去骨瓣减压患者术后ICP差异无统计学意义(P＞0.05).结论 持续有创ICP监测对创伤性急性双侧半球弥漫性脑肿胀的治疗有重要的指导作用,此类患者的预后与入院时ICP、去骨瓣减压患者术前ICP有关.     

去骨瓣减压术对恶性颅内高压者影响的量化分析

目的 对去骨瓣减压术(DC)治疗恶性颅内高压者ICP影响的进行量化分析,研究去骨瓣减压术的临床疗效。方法 对我院收诊的30例恶性颅内压升高患者进行脱水药物治疗及行DC,记录患者的临床资料、GCS(glasgow coma scales)评分及术前、去骨瓣后、剪开硬脑膜后、术后24h及术后每个小时的颅内压,并记录术后6个月患者GOSE评分。结果 患者的术后6个月存活率为80%,恢复良好率为53.3%;术前、去骨瓣时、剪开硬脑膜后、术后24h的ICP分别为39.5±5.3mmHg、24.9±2.8mmHg、7.2±1.3mmHg和13.1±1.5mmHg;去骨瓣时和剪开硬脑膜后均较术前显著降低,差异有显著性(P0.01),术后24h患者ICP均恢复至正常值。结论去骨瓣减压术能够显著降低恶性颅内高压患者的ICP,且剪开硬脑膜降低效果更为明显。     

颅内压监测下改良阶梯减压法结合去骨瓣减压治疗颅内高压的疗效分析

目的探讨颅内压（ICP）监测下改良阶梯减压法结合去骨瓣减压术治疗颅内高压的临床疗效。 方法回顾性分析贵阳市第二人民医院神经外科自2017年1月至2020年6月收治的312例各种病因导致颅内高压需行开颅去骨瓣减压术治疗患者的临床资料,根据患者术中是否采用改良阶梯减压术,将患者分为改良阶梯减压结合去骨瓣减压术组（改良组）和常规开颅去骨瓣减压术组（常规组）,所有患者均在术中实时监测ICP,对比观察2组患者的术中ICP变化、术后并发症及预后情况。 结果312例患者中,常规组154例,改良组158例,常规组术中剪开硬脑膜后ICP值急剧下降后反弹升高并趋于稳定,改良组术中ICP平缓下降后趋于稳定。2组患者的术中脑肿胀、脑膨出、迟发对侧血肿、术后GCS评分、瞳孔变化、并发症、术后6个月的GOS评分比较,差异均具有统计学意义（P<0.05）。 结论ICP监测下改良阶梯减压法处理高颅压患者能有效控制ICP、减免术中脑膨出、减少迟发血肿形成,是一种安全、有效、可行的去骨瓣减压方法。     

颅内压监测下去骨瓣减压术患者预后的分析

目的探讨重型颅脑创伤患者在持续颅内压(ICP)监测下行单侧去骨瓣减压术预后相关因素分析。方法收集我科2015年1月至2016年1月期间收治的16例重型颅脑损伤去骨瓣减压术的临床资料,分析术前瞳孔直径及GCS评分、受伤-开颅间隔、改良CT计分及持续ICP及其对预后的影响,预后以6个月内GOS评分判断。结果预后良好组(GOS 4~5分)7例,预后不良组(GOS 1~3分)9例。两组间在术前改良CT计分、初始ICP、关颅缝皮后ICP、术后24hICP、术前GCS评分、术前瞳孔直径、受伤-开颅间隔时间等方面差异具有统计学意义。结论术前改良CT计分、持续ICP监测在去骨瓣减压术患者中有助于及时发现问题,可指导治疗和评估预后。评估去骨瓣减压术患者预后,ICP优于改良CT计分、瞳孔变化、GCS评分,ICP与预后存在负相关;改良CT计分可反应ICP水平;二者具有重要的临床应用价值。     

颅内压ICP监测指导实施标准去大骨瓣减压术时机对颅内多发脑挫裂伤患者治疗效果观察

目的 探讨颅内压ICP监测指导实施标准去大骨瓣减压术时机对颅内多发脑挫裂伤患者的治疗效果.方法 ICP监测组选择53例颅内多发脑挫裂伤患者,患者入院后行ICP监测,根据ICP选择行标准去大骨瓣减压术手术时机;对照组选择75例既往3 a内CT诊断颅内多发脑挫裂伤,行有限骨瓣开颅去骨瓣减压术患者.对出院后6～12个月随访调...     

Early decompressive craniotomy in children with severe traumatic brain injury

Introduction Decompressive craniectomy remains a controversial procedure in the treatment of raised intracranial pressure (ICP) associated with post-traumatic brain swelling. Although there are a number of studies in adults published in the literature on this topic, most commonly as a salvage procedure in the treatment of refractory raised ICP, there are few that investigate it primarily in children with head injuries.Aim Our aim was to report the experience with decompressive craniotomy in children with severe traumatic brain injury (TBI) at the Red Cross Children's' hospital.Methods This study reports five patients in whom decompressive craniectomy or craniotomy with duraplasty was used as an early, aggressive treatment of raised ICP causing secondary acute neurological deterioration after head injury. The rationale was to save the patient from acute cerebral herniation and to prevent exposure to a prolonged course of intracranial hypertension.Results All patients benefited from the procedure, demonstrating control of ICP, radiological improvement and neurological recovery. Long-term follow-up was available, with outcome assessed at a minimum of 14 months after injury.Discussion The early approach to the use of decompressive craniotomy in the treatment of severe traumatic brain injury (TBI) with secondary deterioration due to raised ICP is emphasised. A favourable outcome was achieved in all of the cases presented. The potential benefit of decompressive craniectomy/craniotomy in the management of children with severe TBI is discussed.     

局部亚低温对颅脑损伤患者去骨瓣减压术后脑膨出并发症的影响

目的 探讨局部亚低温对颅脑损伤患者去骨瓣减压术后脑膨出并发症的控制作用.方法 选取行去骨瓣减压术治疗的重型颅脑损伤患者86例,术后给予常规治疗32例,在常规治疗的基础上加用局部亚低温辅助治疗54例.术后12 h亚低温治疗前对患者行格拉斯哥昏迷评分(GCS),检测颅内压(ICP)、脑灌注压(CPP)及血氧饱和度(SaO2).术后7d判定患者脑膨出情况并再次检测ICP及CPP. 结果常规治疗组与局部亚低温治疗组在年龄、性别、受伤至手术时间分布、亚低温治疗前GCS评分、ICP、CPP及SaO2方面的差异均无统计学意义(P＞0.05).术后7 d亚低温治疗组患者脑膨出发生率、脑膨出程度及ICP均低于常规治疗组,CPP高于常规治疗组,差异均有统计学意义(P＜0.05). 结论 去骨瓣减压术后进行局部亚低温治疗有助于提高CPP、降低ICP,并且减少脑膨出的发生率和脑膨出程度,有利于脑损伤患者功能恢复.     

A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension

Object: The object of our study was to determine, in children with traumatic brain injury and sustained intracranial hypertension, whether very early decompressive craniectomy improves control of intracranial hypertension and long-term function and quality of life. Methods: All children were managed from admission onward according to a standardized protocol for head injury management. Children with raised intracranial pressure (ICP) were randomized to standardized management alone or standardized management plus cerebral decompression. A decompressive bitemporal craniectomy was performed at a median of 19.2 h (range 7.3–29.3 h) from the time of injury. ICP was recorded hourly via an intraventricular catheter. Compared with the ICP before randomization, the mean ICP was 3.69 mmHg lower in the 48 h after randomization in the control group, and 8.98 mmHg lower in the 48 hours after craniectomy in the decompression group (P=0.057). Outcome was assessed 6 months after injury using a modification of the Glasgow Outcome Score (GOS) and the Health State Utility Index (Mark 1). Two (14%) of the 14 children in the control group were normal or had a mild disability after 6 months, compared with 7 (54%) of the 13 children in the decompression group. Our conclusion was that when children with traumatic brain injury and sustained intracranial hypertension are treated with a combination of very early decompressive craniectomy and conventional medical management, it is more likely that ICP will be reduced, fewer episodes of intracranial hypertension will occur, and functional outcome and quality of life may be better than in children treated with medical management alone (P=0.046; owing to multiple significance testing P <0.0221 is required for statistical significance). This pilot study suggests that very early decompressive craniectomy may be indicated in the treatment of traumatic brain injury. Received: 5 May 2000 Revised: 2 September 2000     

双侧平衡去骨瓣减压术对特重型颅脑伤致双瞳散大患者的救治

目的 探讨双侧平衡去骨瓣减压术在治疗特重型颅脑外伤致双瞳散大患者中的作用.方法 对我科2005年1月至2010年12月收治的58例单侧损伤灶所致特重型颅脑外伤致双瞳散大手术患者进行回顾性分析,其中2005年1月至2007年9月仅行病灶侧去骨瓣减压术30例(A组),2007年10月至2010年12月采用双侧平衡去骨瓣减压术28例(B组),分析并比较两组患者颅内压、预后及并发症情况.结果 采用双侧平衡去骨瓣减压术者较仅对血肿侧去骨瓣减压者颅内压下降差异有统计学意义;死亡率下降了25.2%,预后良好率上升了26.9%.结论 双侧平衡去骨瓣减压术可有效降低特重型颅脑外伤致双瞳散大患者的颅内压,减少急性脑膨出和脑梗死的发生率,降低死亡率.

Abstract：

Objective To explore the effect of bilateral balanced decompressive craniectomy in treatment of the most severe brain injured patients with bilateral mydriasis. Methods Fifty - eight cases of the most severe brain injury due to unilateral lesions with bilateral mydriasis were analyzed retrospectively from Jan 2005 to Dec 2010. Thirty were treated by unilateral decompressive craniectomy from Jan 2005 to Sep 2007(group A) and 28 by bilateral balanced decompressive craniectomy from Oct 2007 to Dec 2010(group B). The intracranial pressure, prognosis and complications were compared. Results Postoperative ICP was significantly lower in group B than group A; patients in group B had a lower mortality and better outcome than in group A. Conclusion Bilateral balanced decompressive craniectomy can efficiently reduce the values of ICP, occurrence of acute encephalocele and brain infarction and mortality of the most severe brain injured patients with bilateral mydriasis.     

Analysis of Complications Following Decompressive Craniectomy for Traumatic Brain Injury

Objective

Adequate management of increased intracranial pressure (ICP) is critical in patients with traumatic brain injury (TBI), and decompressive craniectomy is widely used to treat refractory increased ICP. The authors reviewed and analyzed complications following decompressive craniectomy for the management of TBI.

Methods

A total of 89 consecutive patients who underwent decompressive craniectomy for TBI between February 2004 and February 2009 were reviewed retrospectively. Incidence rates of complications secondary to decompressive craniectomy were determined, and analyses were performed to identify clinical factors associated with the development of complications and the poor outcome.

Results

Complications secondary to decompressive craniectomy occurred in 48 of the 89 (53.9%) patients. Furthermore, these complications occurred in a sequential fashion at specific times after surgical intervention; cerebral contusion expansion (2.2 ± 1.2 days), newly appearing subdural or epidural hematoma contralateral to the craniectomy defect (1.5 ± 0.9 days), epilepsy (2.7 ± 1.5 days), cerebrospinal fluid leakage through the scalp incision (7.0 ± 4.2 days), and external cerebral herniation (5.5 ± 3.3 days). Subdural effusion (10.8 ± 5.2 days) and postoperative infection (9.8 ± 3.1 days) developed between one and four weeks postoperatively. Trephined and post-traumatic hydrocephalus syndromes developed after one month postoperatively (at 79.5 ± 23.6 and 49.2 ± 14.1 days, respectively).

Conclusion

A poor GCS score (≤ 8) and an age of ≥ 65 were found to be related to the occurrence of one of the above-mentioned complications. These results should help neurosurgeons anticipate these complications, to adopt management strategies that reduce the risks of complications, and to improve clinical outcomes.     

动态颅内压监测对重型颅脑损伤标准大骨瓣减压术后治疗的意义

目的探讨动态颅内压(ICP)监测对重型颅脑损伤(sTBI)标准大骨瓣减压术治疗的指导意义。方法对62例(监测组)sTBI标准大骨瓣减压患者术后行ICP监测,根据ICP值调整治疗方案,并与同期未行ICP监测的46例(常规组)sTBI标准大骨瓣减压患者的疗效、并发症及甘露醇应用的时间和计量作比较。结果监测组脱水剂应用时间及剂量较未监测组低,监测组急性肾功能损伤和电解质紊乱发生率较未监测组低,而肺部感染、尿路感染和上消化道出血等三种并发症方面差异无统计学意义;监测组预后优于常规组。结论动态ICP监测能较好地反应sTBI标准大骨瓣减压术后ICP的变化,通过个体化治疗能有效控制ICP,维持脑灌注压,减少并发症,降低sTBI的致残率和病死率。     

Neurological improvement after cranioplasty - analysis by transcranial doppler ultrasonography.

Cranioplasty can improve neurological status in patients with skull bone defects. The mechanism of postoperative improvement in neurologic status might be increased cerebral blood flow (CBF) velocity due to elimination of the effects of atmospheric pressure. Between May 2001 and June 2002, 13 patients (8 men and 5 women; average age, 46 years; range, 21-65 years) were studied. Postoperative changes in neurological status and blood flow velocity were examined and compared using transcranial Doppler (TCD) sonography. The mean interval between craniectomy and cranioplasty was 122.3+/-100.4 days. The mean interval between cranioplasty and performance of TCD examination was 15.2+/-2.8 days. The results showed significant improvements after cranioplasty in GCS, arm muscle power, and Barthel Index. While the CBF velocities tended to increase after cranioplasty, only the increase in the non-lesion side middle cerebral artery (MCA) was statistically significant. The interval from decompressive craniectomy to cranioplasty and neurological status change before and after cranioplasty was significantly negatively correlated. We conclude that cranioplasty can improve neurological status, and it should be performed as earlier as edema has resolved.     

腰大池持续引流术联合骨瓣减压控制术治疗对重型颅脑损伤患者并发症和预后的影响

目的探讨腰大池持续引流术联合骨瓣减压控制术治疗对重型颅脑损伤患者并发症和预后的影响,以期为优化该类患者外科治疗提供参考性依据。方法选取2013年2月~2016年4月我院收治的重型颅脑损伤患者184例,按数字随机表法分为试验组和对照组,各92例,对照组患者采取骨瓣减压控制术治疗,试验组患者则在对照组患者的基础上联合腰大池持续引流术治疗,分别于术后3d、5d、7d检测患者颅内压(ICP),于术后6个月时采格拉斯哥预后评分(GPS)评估两组患者预后情况,详细记录两组患者脑水肿、脑梗死等术后并发症发生情况,并进行组间比较。结果试验组患者术后3d、5d、7d ICP值均明显低于对照组患者,差异具有统计学意义(P0.05);术后3d、5d、7d时试验组患者GCS评分均明显高于对照组患者,差异均具有统计学意义(P0.05);与对照组患者比较,试验组患者术后脑水肿发生率明显降低,脑水肿程度也明显减轻,差异均具有统计学意义(P0.05);与对照组患者比较,试验组患者术后脑梗死发生率明显降低,且梗死体积也明显缩小,差异均具有统计学意义(P0.05);术后6个月时,试验组患者预后良好率、预后不良率和死亡率分别为59.78%(55/92)、33.70%(31/92)、6.52%(6/92),对照组患者分别为39.13%(36/92)、50.00%(46/92)、10.87%(10/92),两组患者术后预后情况差异具有统计学意义(P0.05)。结论腰大池持续引流术联合骨瓣减压控制术治疗对重型颅脑损伤患者的疗效显著,可有效降低ICP,改善预后,降低术后并发症的发生,效果优于仅采用骨瓣减压控制术。     

开颅术后经硬膜下引流管测量颅内压的可行性分析

目的 探讨开颅术后经硬膜下引流管监测颅内压（ICP）的可行性与效果。方法 2020年1月至2022年8月前瞻性选择开颅手术治疗的病人56例,术中将ICP监测探头置入脑室并使用Codman颅内压监护仪连续监护1周（金标准）;同时,应用液压耦合装置经术后留置硬膜下引流管测量ICP（硬膜下法）。结果 56例金标准测得的ICP[(13.34±5.41)mmHg]与硬膜下法测得的ICP[(14.96±5.33)]无统计学差异（P>0.05）。去骨瓣减压术25例金标准测得的ICP[(13.76±5.14)mmHg]与硬膜下法测得的ICP[(14.68±4.71)mmHg]无统计学差异（P>0.05）。未去骨瓣31例金标准测得的ICP[(13.00±5.66)mmHg]与硬膜下法测得的ICP[(15.03±5.80)mmHg]无统计学差异（P>0.05）。硬膜下法测得的ICP与金标准的差值为（1.6±2.1）mmHg;两种方法测得的ICP呈明显正相关（r=0.892,P<0.001）。术后发生颅内感染1例（1.78%）、颅内少量出血1例（1.78%）。结论 与脑室ICP监测相...     

Cerebral edema leading to decompressive craniectomy: an assessment of the preceding clinical and neuromonitoring trends

The aim of this study was to examine the pre-operative clinical and neuromonitoring courses in patients with a decompressive craniectomy to assess and to compare clinical and neuromonitoring signs indicating extensive cerebral edema. We conducted a retrospective analysis of the clinical signs and courses of simultaneous monitoring of intracranial pressure (ICP) and cerebral oxygenation (PtiO2) in 26 consecutive patients who were sedated and treated with a decompressive craniectomy due to extensive cerebral edema after aneurysmal subarachnoid hemorrhage (SAH) (n = 20) or severe head injury (SHI) (n = 6). Pathological monitoring trends always preceded clinical deterioration. In 18 of 26 patients extensive cerebral edema was indicated solely by increasing ICP > 20 mmHg or decreasing PtiO2 < 10 mmHg or both. Anisocoria occurred in only 8 of 26 patients. As opposed to SHI patients, 9 of 20 SAH patients showed decreasing PtiO2 as first warning sign clearly before neurological deterioration or ICP increase. This series shows the utility of combined ICP and PtiO2 monitoring in patients who develop extensive cerebral edema. Pathological monitoring trends indicate deterioration prior to clinical signs which offers a wider therapeutical window. PtiO2 monitoring appears to be particularly valuable after aneurysmal SAH as adjunct to ICP monitoring and CT imaging.