An Alternative Treatment for Brain Herniation?

Despite the high mortality associated with transtentorial herniation (TTH), meaningful recovery can be achieved with aggressive treatment to reduce intracranial volume. Medical therapy typically entails elevating serum osmolarity to create an osmotic gradient that forces water out of the brain. Although mannitol is the recommended hyperosmolar agent for reducing intracranial pressure (ICP), it may reduce intravascular volume through diuresis, thereby compromising cerebral perfusion pressure, which could have a deleterious effect on outcomes for brain-injured patients.

One alternative hyperosmolar agent that has shown promise in reducing ICP with fewer adverse effects is hypertonic saline. To investigate its efficacy and safety in treating TT…