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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 119-125
DOI: 10.4103/ajns.AJNS_179_20
Original Article

Lifesaving decompressive craniectomy for high intracranial pressure attributed to deep-seated meningioma: Emergency management

Irwan Haq
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya
,
Fajar Niantiarno
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya
,
Muhammad Arifianto
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya
,
Alhusain Nagm
1   Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Nasr City, Cairo, Egypt
2   Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka
,
Rahadian Susilo
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya
,
Joni Wahyuhadi
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya
,
Takeo Goto
1   Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Nasr City, Cairo, Egypt
,
Kenji Ohata
1   Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Nasr City, Cairo, Egypt
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Objects: As the most common intracranial extra-axial tumor among adults who tend to grow slowly with minimal clinical manifestation, the patients with meningioma could also fall in neurological emergency and even life-threatening status due to high intracranial pressure (ICP). In those circumstances, decompressive craniectomy (DC) without definitive tumor resection might offer an alternative treatment to alleviate acute increasing of ICP. The current report defines criteria for the indications of lifesaving DC for high ICP caused by deep-seated meningioma as an emergency management. Patients and Methods: This study collected the candidates from 2012 to 2018 at Dr. Soetomo General Hospital, Surabaya, Indonesia. The sample included all meningioma patients who came to our ER who fulfilled the clinical (life-threatening decrease in Glasgow Coma Scale [GCS]) and radiography (deep-seated meningioma, midline shift in brain computed tomography [CT] >0.5 cm, and diameter of tumor >4 cm or tumor that involves the temporal lobe) criteria for emergency DC as a lifesaving procedure. GCS, midline shift, tumor diameter, and volume based on CT were evaluated before DC. Immediate postoperative GCS, time to tumor resection, and Glasgow Outcome Scale (GOS) were also assessed postoperation. Results: The study enrolled 14 patients, with an average preoperative GCS being 9.29 ± 1.38, whereas the mean midline shift was 15.84 ± 7.02 mm. The average of number of tumor's diameter and volume was 5.59 ± 1.44 cm and 66.76 ± 49.44 cc, respectively. Postoperation, the average time interval between DC and definitive tumor resection surgery was 5.07 ± 3.12 days. The average immediate of GCS postoperation was 10.07 ± 2.97, and the average GOS was 3.93 ± 1.27. Conclusion: When emergency tumor resection could not be performed due to some limitation, as in developing countries, DC without tumor resection possibly offers lifesaving procedure in order to alleviate acute increasing ICP before the definitive surgical procedure is carried out. DC might also prevent a higher risk of morbidity and postoperative complications caused by peritumoral brain edema.

Key-words:

Decompressive craniectomy - lifesaving - meningioma - skull base surgery

Financial support and sponsorship

Nil.




Publication History

Received: 27 April 2020

Accepted: 14 August 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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