Jacob L Freeman1, Ken R Winston, Joshua T Byers, Kathryn Beauchamp. 1. From the Department of Neurosurgery (J.L.F., K.R.W., J.T.B., K.B.), The University of Colorado School of Medicine; and University of Colorado Hospital (J.L.F., K.R.W., J.T.B.), Aurora; and Denver Health and Hospitals (J.L.F., K.R.W., K.B.), Denver, Colorado.
Abstract
BACKGROUND: The objective of this study was to review the efficacy of intracranial packing as a means of tamponade for life-threatening intraoperative hemorrhage that was refractory to more common techniques for achieving hemostasis. METHODS: Neuroimaging and hospital records were reviewed for the seven adult patients who had experienced life-threateningly severe hemorrhage during intracranial surgery and in whom packing was used to control the bleeding. All packing was left in place at the time of closure and was removed when the patient's condition was considered safe for a second operation. RESULTS: Hemorrhage was successfully halted in all seven patients, and all survived their operations. Six were discharged from the hospital, but one patient with severe parenchymal injury from trauma and multiple medical comorbidities died on postoperative Day 2 after supportive care was withdrawn. Four had an improved Glasgow Outcome Scale (GOS) score at the time of last follow-up, and two of these improved from dependent to independent living. There were no postoperative intracranial or wound infections. CONCLUSION: Intracranial packing to tamponade severe intracranial hemorrhage can be a lifesaving neurosurgical maneuver. LEVEL OF EVIDENCE: Therapeutic study, level V.
BACKGROUND: The objective of this study was to review the efficacy of intracranial packing as a means of tamponade for life-threatening intraoperative hemorrhage that was refractory to more common techniques for achieving hemostasis. METHODS: Neuroimaging and hospital records were reviewed for the seven adult patients who had experienced life-threateningly severe hemorrhage during intracranial surgery and in whom packing was used to control the bleeding. All packing was left in place at the time of closure and was removed when the patient's condition was considered safe for a second operation. RESULTS:Hemorrhage was successfully halted in all seven patients, and all survived their operations. Six were discharged from the hospital, but one patient with severe parenchymal injury from trauma and multiple medical comorbidities died on postoperative Day 2 after supportive care was withdrawn. Four had an improved Glasgow Outcome Scale (GOS) score at the time of last follow-up, and two of these improved from dependent to independent living. There were no postoperative intracranial or wound infections. CONCLUSION: Intracranial packing to tamponade severe intracranial hemorrhage can be a lifesaving neurosurgical maneuver. LEVEL OF EVIDENCE: Therapeutic study, level V.
Authors: Ramiro Manzano-Nunez; Julian Chica; Alexandra Gómez; Maria P Naranjo; Harold Chaves; Luis E Muñoz; Javier E Rengifo; Isabella Caicedo-Holguin; Juan C Puyana; Alberto F García Journal: Eur J Trauma Emerg Surg Date: 2020-06-28 Impact factor: 3.693