To explore the treatment effect of hypertonic saline on the brain herniation due to hyponatremia in Neurosurgery patient.

The clinical data of 5 patients enrolled in our department from January 2014 to November 2016 were retrospectively analyzed. All the neurosurgery patients had brain herniation due to hyponatremia. Their diagnoses included head trauma, brain tumor, and spontaneous subarachnoid hemorrhage due to aneurysm. The brain herniation happened 4 to 16 d after brain injury or operation, because of the increased intracranial pressure (ICP) due to hyponatremia and brain edema subsequently. As the brain herniation occurred due to hyponatremia, the infusion of 2% hypertonic saline was intitated immediately. The goal of treatment was the serum sodium level being 145-155 mmol/l.

The patients accepted hypertonic saline injection immediately, and the conditions ameliorated when the hyponatremia was corrected. The brain herniation was reversed, and no patient underwent decompressive craniectomy. The serum sodium level when brain herniation occurred was (121.80±5.12) mmol/l, then increased to (144.60±5.13) mmol/l when the brain herniation was reversed. The paired t test showed the difference between the two groups of the serum sodium levels was statistically significant (t=-5.419, P<0.05). The 5 patients were all recovered smoothly. The GOS of 4 patients were 5, and 1 patient scored 4. No complications such as central pontine myelinolysis occurred.

The brain edema duration of Neurosurgery patients is prolonged, and the pathophysiology of brain edema is complex, so water-electrolyte disturbance is readily to occur. Hyponatremia may cause brain edema and increased ICP, even brain herniation, with the characteristic of sudden onset and fast exacerbation. Hypertonic saline infusion could have potent effect to ameliorate such condition, may even reverse brain herniation and gain good outcome.