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G Ketter

Publications and source records attributed to G Ketter.

3 recordsLinked to original sources
PubMed2005

Relevance of ICP and ptiO2 for indication and timing of decompressive craniectomy in patients with malignant brain edema.

BACKGROUND: The exact effects of decompressive craniectomy on intracranial pressure (ICP) and cerebral tissue oxygenation (ptiO2) are still unclear. Therefore, we have monitored ICP and ptiO2 intra-operatively and correlated these values to different operative steps during craniectomy. METHODS: ICP and ptiO2 values have been monitored both, simultaneously and continuously, in 15 patients with cerebral edema due to posttraumatic or postischemic brain swelling. Indications for craniectomy were an increase in ICP above 25 mmHg or a decrease in ptiO2 below 10 mmHg resistant to conservative treatment (e.g. mannitol, hyperventilation, adequate arterial blood oxygenation, etc.). In all cases, we performed a fronto-temporo-parietal craniectomy (15 x 12 cm) and dura enlargement with galea-periosteum. During craniectomy, monitoring of ICP and ptiO2 in the affected hemisphere was continued. Values were recorded and correlated with the different operative steps. FINDINGS: We performed craniectomy according to our treatment protocol in 5 patients. Prior to surgery, mean ICP values were 25.6 mmHg (range: 23-29 mmHg), mean ptiO2 values were 5.9 mmHg (range: 2.4-9.5 mmHg), and mean CPP values were 66 mmHg (range: 60-70 mmHg). After removing the bone flap, ICP values dropped to physiological values (mean: 7.4 mmHg), whereas ptiO2 values increased only slightly (mean: 11 mmHg). Opening of the dura resulted in a further decrease of ICP (mean 4.8 mmHg) and an increase of ptiO2 to normal limits (mean: 18.8 mmHg). After skin closure, mean ICP was 6.8 mmHg and mean ptiO2 was 21.7 mmHg, respectively. We found a significant decrease of ICP after craniectomy (p<0.042) and after dura enlargement (p<0.039) as well as a statistically significant increase in ptiO2 after craniectomy (p<0.043) and after dura enlargement (p<0.041). CONCLUSION: As a large bone flap in decompressive craniectomy is essential for adequate ICP reduction, the results of the presented cases suggest that dura enlargement is the crucial step to restore adequate brain tissue oxygenation and that ptiO2 monitoring could be an important tool for timing craniectomy in the future.

Adolescent↗
PubMed1995

[Dura-plasty in intracranial operations].

Due to recent reports of slow-virus infections related to the use of lyophilized homologous grafts for duraplasty, we have reviewed the concept of dura substitution in cranial neurosurgery. The present study is based upon 2,115 cranial operations from 1991 to 1994. Frequency and complications of different grafts were investigated retrospectively. Within this time period, dura substitution was required with a frequency of 23.4%. In most cases, autologous tissue was used (47.5%), followed by lyophilized or dehydrated and gamma-radiated homologous cadaveric dura and fascia lata (41.8%). In addition, a synthetic polyesterurethane fleece was used since April 1994. In transsphenoidal approaches to the pituitary gland, autologous fascia lata with or without muscle was used exclusively (100%). In frontobasal trauma, plastic covering of the frontal skull base was performed predominantly by autologous galea-periost (84.8%). In contrast, homologous tissues were preferred for duraplasty in the posterior cranial fossa (77.9%). Complications, including CSF fistula, inflammation, pneumatocephalus, and pseudocysts were observed in 13.1% of operations with dura substitution. The rate of complications was highest in infratentorial (20.0%) and frontobasal operations (18.8%). Application of synthetic grafts for 9 months has reduced complications (6.3%). In conclusion, duraplasty should be generally performed by implantation of autologous grafts such as galea-periost or fascia lata. No restriction of this principle should be accepted for surgery in inflammation, after open brain injury, in the frontobasal region and in transsphenoidal approaches to the pituitary gland. In all other cases, insertion of synthetic grafts seems to be equal to the use of autologous tissue, and even superior in large dural defects.(ABSTRACT TRUNCATED AT 250 WORDS)

Biological Dressings↗