Management of Severe Coma in Infants with Peracute Intracranial Hypertension Due to Brain Oedema and/or Intracranial Haematoma. Value of Emergency Decompressive Craniotomy

Abstract

In severe intracranial hypertension there are two basic causes of death: compression of the brain stem and complete cessation of cerebral blood flow. The disproportion between the volume of the intracranial space and the enlarged content may be solved by two surgical procedures:
1. by enlarging the volume of the cranial cavity, or
2. by reducing the content within the intracranial space.

Trying to achieve a correct diagnosis using cerebral angiography unduly prolonged the period of the severe condition. Hence the author performs extensive hemicraniectomy, localized according to the neurological symptomatology, immediately after neurosurgical examination. Indications for this operation are states of severe intracranial hypertension with "stone like" hard fontanelle, signs of brain stem lesion, and disturbances of respiration. The value and necessity of emergency external decompression is demonstrated in case reports of 6 infants with acute intracranial hypertension.

Zusammenfassung

Bei schwerer intrakranieller Drucksteigerung wird der Tod durch Kompression des Hirnstamms und dem völligen Sistieren der zerebralen Durchblutung hervorgerufen. Das Mißverhältnis zwischen intrakraniellem Raum und vergrößertem Inhalt kann chirurgisch durch Vergrößerung der Schädelhöhle gelöst werden. Die vom Autor sofort an die neurologische Untersuchung angeschlossene Hemikraniektomie beim Vorliegen schwersten Hirndrucks (Hirnstammzeichen-Atemstörungen) wird in ihrem Wert anhand eines Berichtes über 6 Kinder aufgezeigt.