The relationship between intracranial pressure and the degree of brain swelling in patients subjected to infratentorial surgery.

BACKGROUND: In patients with supratentorial tumours, intracranial pressure is a strong predictor of intra-operative brain swelling and thresholds for ICP associated with brain swelling have been defined. Whether these ICP thresholds can be applied during infratentorial surgery is uncertain. We studied the relationship between subdural ICP and the degree of brain swelling after opening of the dura mater in patients subjected to infratentorial surgery. Thresholds for ICP associated with brain swelling were defined.

METHODS: One hundred and nine adult patients subjected to infratentorial surgery were studied. Subdural ICP was measured immediately before opening of the dura and the degree of brain swelling was estimated by the neurosurgeon according to a four-point scale.

FINDINGS: At ICP less than 7 mmHg brain swelling did not occur. In the range from 7 to 13 mmHg 21 of 39 patients (54%) had moderate swelling, but not pronounced swelling. At ICP greater than 13 mmHg some degree of swelling occurred in all patients, and at ICP exceeding 24 mmHg pronounced cerebral swelling was found in all patients. Using logistic regression analysis specific thresholds for ICP associated with brain swelling were defined as follows: at an ICP equal to or greater than 13 mmHg, brain swelling occurred with 95% probability; and at an ICP less than 6 mmHg brain swelling occurred with 5% probability.

CONCLUSIONS: Subdural ICP measured before opening of the dura mater can predict the risk of brain swelling during infratentorial surgery. Thresholds for ICP associated with brain swelling are close to thresholds defined in patients undergoing supratentorial surgery.