Intracranial Pressure and Neuromonitoring in Brain Injury: Proceedings of the Tenth International ICP Symposium, Williamsburg, Virginia, May 25–29, 1997

444 Pages·1998·34.54 MB·English

by  Alicia Ausina Aguilar M.D.

Acta Neurochirurgica
Supplements
Editor: H.-J. Reulen
Assistant Editor: H.-J. Steiger
Intracranial Pressure and
Ne uromonitoring in Brain Injury
Proceedings of the Tenth International ICP Symposium,
Williamsburg, Virginia, May 25-29, 1997
Edited by
A. Marmarou, R. Bullock,
C. Avezaat, A. Baethmann,
D. Becker, M. Brock, 1. Hoff,
H. Nagai, H.-1. Reulen,
G. Teasdale
Acta Ne urochirurgica
Supplement 71
Springer-Verlag Wien GmbH
Anthony Marmarou, Ph.D. Mario Brock, M.D.
Medical College of Virginia, Richmond, Virginia, U.S.A. University of Berlin, Berlin, Germany
Ross Bullock, M.D., Ph.D. Julian Hoff, M.D., Ph.D.
Medical College of Virginia, Richmond, Virginia, U.S.A. University of Michigan, Ann Arbor, Michigan, U.S.A.
Cees Avezaat, M.D. Hajime Nagai, M.D.
University Hospital Rotterdam, Rotterdam, The Netherlands Nagoya City University, Nagoya, Japan
Alexander Baethmann, M.D., Ph.D. Hans-J. Reulen, M.D.
University ofMunich, Munich, Germany Ludwig Maximilians University. Munich, Germany
Donald Becker, M.D. Graham Teasdale, M.D.
UCLA School of Medicine, Los Angeles, Califomia, U.S.A. Institute of Neurological Sciences. Glasgow, U.K.
Proceedings of the Tenth International Symposium on Intracranial
Pressure and Neuromonitoring in Brain Injury
Honorary Board: J. W. F. Beks, S. Ishii, T. W. Langfitt, N. Lundberg
Organizing Committee: W. Broaddus, R. Bullock, S. Crute, J. Dunbar, K. Holloway, A. Marmarou,
R. Merchant, 1. Ward, H. Y oung
A.dvisory Board: C. J. J. Avezaat, A. Baethmann, D. P. Becker, M. Brock, J. T. Hoff, A. Marmarou,
1. D. Miller t, H. Nagai, G. M. Teasdale
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© 1998 Springer-Verlag Wien
Originally published by Springer-Verlag Wien New York in 1998
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SPIN: 10664953
With 176 Figures
Llbrary of Congress Catalog1ng-ln-Publfcatlon Oata
Internat10nal ICP SYMpos1um (10th: 1997 : W1111amsburg, Va.)
Intracran1al pressure and neuroMon1tor1ng 1n bra1n 1njury
proceed1ngs of the Tenth Internat10nal ICP Sympos1um, W1111amsburg,
May 25-29, 1997 I ed1ted by A. Marmarou ... let aLl.
p. cm. -- (Acta neuroch1rurg1ca. Supplementum 71)
Includes b1bl1ograph1cal references and 1ndex.
ISBN 978-3-7091-7331-2 ISBN 978-3-7091-6475-4 (eBook)
DOI 10.1007/978-3-7091-6475-4
1. Bra1n damage--Congresses. 2. Intracranlal hypertenslon
-Congresses. 3. Intracran1al pressure--Congresses. 4. Cerebral
c1rculation--Congresses. I. Marmarou, Anthony. 11. T1tle.
III. Ser1es.
[DNLM: 1. Bra1n InjUrles--compllcatlons congresses.
2. Intracran1al Pressure congresses. 3. Monltorlng, PhysiologIe
congresses WL 354 15971 19981
RC387.5.I48 1997
616.8'047--dc21
DNLM/DLC
for L1brary of Congress 98-16255
CIP
ISSN 0065-1419
ISBN 978-3-7091-7331-2
This volume isdedicatedto the memoryofour
dearfriend andcolleague
J. DouglasMiller, M.D., Ph.D.
1937-1995
ProfessorofNeurosurgery
University ofEdinburgh
Preface
The first international symposium on intracranial pressure was held in Hannover Germany in 1972, and 8
symposiahave been held since that time in all parts ofthe world. This volume provides a summary ofthe tenth
symposiumwhichwas heldinWilliamsburg, Virginia, and marked the25th anniversaryofourinitial meeting.In
thesepast25years,significantstrideshavebeenmadeinunderstandingthecauseandeffectsofraisedintracranial
pressure,andthissymposiumrepresentedamilestoneinourquestforknowledgetohelpimprovepatientoutcome.
Itisherethatweexpandedthe scopeofourmeeting to includeadditionalforms ofneuromonitoringtoprovidea
broaderviewofthepathophysiologicchangesoccurringininjuredordiseasedbrain.Importantcontributionswere
madeinexperimentalandclinicalstudiesofbraintissueoxygen,neurochemicalmeasuresutilizingmicrodialysis,
jugularoximetry, nearinfrared spectroscopy, cerebral bloodflow and magnetic resonance spectroscopy to name
afew. These othermonitoring modalities were welcomed atourICP symposium and it is natural that results of
these additional probes intothe brain arediscussed inconcertwith thefirst brain probe, intracranial pressure.
The Williamsburg symposium attracted 417 scientists from all parts of the world and 298 abstracts were
acceptedforpresentationatthemeeting. Atotalof182manuscriptsweresubmittedandofthese, 107manuscripts
were selected for expanded publication. The remainderofthe abstracts (191) are also published in this volume.
The top six categories containing most abstracts are: Pathophysiology ofICP, Hydrocephalus, Traumatic Brain
Injury, Management ofICP and CPP, Brain Oxygen Monitoring and Neuromonitoring in the ICU. Combined,
thesetopicsaccountedfor65%oftheabstracts.Thesymposiumalsoscheduledseveralworkshops,whichallowed
theveteranscientistsmoretimetodiscusstheirresearchandrecommendnewareasofinvestigationtotheyounger
investigators. These workshops were fully attended by the participants and expanded our knowledge base. In
addition,aspecialsatellitemeetingof"NeurochemicalMonitoringintheIntensiveCareUnit"washeldfollowing
theICPsymposium, whichattracted more scientiststopresenttheirmostrecentfindings and tocomplementour
general themeofneuromonitoring. These manuscripts arecontainedin aseparate volume.
We were alsofortunate during the opening ceremony to hear videotaped introductory commentsby Professor
Lundberg, who is doing well and enjoying retirement on the farm of his parents in Lund, Sweden. Professor
Lundberg commented on the fact that the ICP symposia are an odd phenomenon in the jungle of medical
associations, sincethere is no permanentorganization, no president, nostaff, noformal membership, no society,
no written rules, etc. etc. How is it possible, he asked, that such a loosely built association has been kept living
during 25 years, prospering and developing in to an almost indispensable ingredientofscientific neurosurgery?
Wefound the answer in Williamsburg where the numberofnew investigators represented a large percentage of
participants. TheICPsymposiafor the past25 years have welcomed these young scientists to thefield and have
providedafertile ground to learn, grow andeventually becomethe seasoned investigators thatbrain research so
desperately needs.
Thescientificworkspresentedin this volumedocumentthecurrentstateoftheartinICPresearchandthefield
of neuromonitoring. We look forward to continued progress at our next symposium to be held in Cambridge,
England, in the year 2000. Finally, we wish to acknowledge the competent collaboration ofR. Petri-Wieder of
Springer-Verlag, Viennain the production ofthis volume.
Anthony Marmarou
on behalfofthe Advisory Board
Contents
ManagementofICPand CPP
Ausina, A, Baguena, M., Nadal, M., Manrique, So, Ferrer, Ao, Sahuquillo, Jo, Garnacho, Ao:
CerebralHemodynamicChanges during Sustained Hypocapniain SevereHeadInjury:
Can Hyperventilation Cause Cerebral Ischemia?
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Biestro, A, Barrios, Eo, Baraibar, Jo, Puppo, c., Lupano, Do, Cancela, M., Borovich, 8., Pouso, Jo:
UseofVasopressors to RaiseCerebral Perfusion Pressure in HeadInjured Patients 5
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
de Nadal, M., Ausina, A, Sahuquillo, Jo, Pedraza, So, Garnacho, Ao, Gancedo, Vo A:
Effects on Intracranial Pressure ofFentanyl in SevereHead Injured Patients 10
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Heinsoo, M., Eelmiie, Jo, Kuklane, Mo, Tomberg, T., Tikk, A, Asser, T.:
ThePossibleRole ofCSFHydrodynamic Parameters Following in ManagementofSAH Patients 13
0 0 0 0 0 0
Kunze, E., Meixensberger, Jo, Janka, M., Sorensen, N., Roosen, K.:
DecompressiveCraniectomy in Patients with UncontrollableIntracranial Hypertension 16
Myburgh, Jo A, Upton, Ro N., Grant, c., Martinez, A:
AComparison ofthe Effects ofNorepinephrine, Epinephrine, and Dopamine on Cerebral BloodFlow
and Oxygen Utilisation 19
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nara, lo, Shiogai, T., Hara, M., Saito, lo:
ComparativeEffects ofHypothermia, Barbiturate, and Osmotherapy for Cerebral Oxygen Metabolism,
Intracranial Pressure, andCerebral Perfusion Pressure in Patients with SevereHead Injury 22
0 0 0 0 0 0 0 0 0 0 0
Poca, M. A, Sahuquillo, Jo, Baguena, M., Pedraza, So, Gracia, Ro Mo, Rubio, Eo:
IncidenceofIntracranial Hypertension afterSevereHead Injury: AProspective Study Using the
Traumatic ComaDataBank Classification 27
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • 0 0
Schatzmann, c., Heissler, H. E., Konig, K., Klinge-Xhemajli, Po, Rickels, Eo, Muhling, M.,
Borschel, M., Samii, M.:
TreatmentofElevatedIntracranial Pressure by Infusionsof 10% Salinein Severely Head Injured
Patients 31
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Takagi, H., Tsuyusaki, H., Endo, M., Kitahara, T.:
Pharmacokinetics ofSerum Glycerol andChanges ofICP: Comparison ofGastric and Duodenal
Administration . 34
0 0 • 0 0 • 0 0 0 0 0 0 0 0 0 • 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • 0 0 • 0 0 • 0 •• 0 • 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 •• 0
Willemse, Ro Bo, Egeler-Peerdeman, So Mo:
ExternalLumbarDrainage in Uncontrollable Intracranial Pressure in Adults with SevereHeadInjury:
AReportof7Cases 37
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x Contents
ICPMeasurementTechniques
Brennan, J., Tompkins, P., Stevens, F A., Carter, L. P.:
ICP-CBFTraumaBolt, Laboratory Evaluation ............................................... 40
Chambers, I. R., Kane, P. J., Signorini, D. F., Jenkins, A., Mendelow, A. D.:
BilateralICPMonitoring: Its Importance in Detecting the SeverityofSecondary Insults 42
Fernandes, H M., Bingham, K., Chambers, I. R., MendelowA. D.:
Clinical EvaluationoftheCodman MicrosensorIntracranial PressureMonitoring System 44
Guyot, L. L., Dowling, C, Diaz, F G., Michael, D. B.:
Cerebral MonitoringDevices: Analysis ofComplications 47
Khan, S. H, Kureshi, I. u., Mulgrew, T, Ho, S. Y, Onyiuke, H C:
Comparison ofPercutaneous Ventriculostomies and Intraparenchymal Monitor:
ARetrospective Evaluation of 156Patients 50
Massager, N., Wayenberg, J.-L., Vermeylen, D., Brotchi, J.:
Anterior FontanellePressure Recording with the RotterdamTransducer:
VariationofNormal Parameters with Age 53
Mindermann, Th., Gratzl, 0.:
Interhemispheric Pressure Gradients in SevereHeadTraumain Humans 56
Raabe, A., StOckel, R., Hohrein, D., Schoche, J.:
An AvoidableMethodological Failure in Intracranial Pressure Monitoring Using Fiberoptic
orSolidStateDevices 59
Schneider, G.-H, Sarra/zadeh, A. S., Kiening, K. L., Bardt, T F, Vnterberg, A. W, Lanksch, W R.:
InfluenceofHyperventilation on Brain Tissue-P02, PC02, and pHinPatients with Intracranial
Hypertension 62
Veno, T, Ballard, R. E., Shuer, L. M., Cantrell, J. H, Yost, W T, Hargens, A. R.:
Non-InvasiveMeasurementofPulsatileIntracranialPressures Using Ultrasound 66
Wayenberg, J.-L.:
NoninvasiveMeasurementofIntracranial Pressure in Neonates and Infants: Experience with the
RotterdamTeletransducer 70
NeuromonitoringinIntensive Care
Czosnyka, M., Smielewski, P., Kirkpatrick, P., Piechnik, S., Laing, R., Pickard, J. D.:
Continous Monitoring ofCerebrovascularPressure-Reactivity in Head Injury. ..................... 74
Mayevsky, A., Manor, T, Meilin, S., Doron, A., Ouaknine, G. E.:
Real-Time Multiparametric Monitoring ofthe Injured HumanCerebral Cortex- aNew Approach 78
w.,
Miller, J. I., Chou, M. Capocelli, A., Bolognese, P., Pan, J., Milhorat, T H:
ContinousIntracranial Multimodality Monitoring Comparing LocalCerebral BloodFlow, Cerebral
Perfusion Pressure, and MicrovascularResistance 82
Contents XI
Nakamura, T, Nagao, S., Kawai, N, Honma, Y, Kuyama, H:
SignificanceofMultimodal Cerebral Monitoring underModerateTherapeutic Hypothermiafor Severe
HeadInjury ........................................................................... 85
Rosahl, S. K., Schuhmann, M. U, Thomas, S., Brinker, T, Samii, M.:
Brain-StemAuditory EvokedPotential Monitoring in Experimental DiffuseBrain Injury. ............ 88
Rossi, S., Buzzi, F., Paparella, A., Mainini, P., Stocchetti, N:
Complications and Safety Associated with ICPMonitoring: AStudyof542 Patients 91
Shiogai, T, Nagayama, K., Damrinjap, G., Saruta, K., Hara, M., Saito, 1.:
Morphological and Hemodynamic Evaluations by Means ofTranscranial PowerDopplerImaging in
Patients with Severe Head Injury. ......................................................... 94
Tanaka, K., Kim, A., Naruse, H, Hakuba, A.:
TheEffectofExperimental Spinal CordEdemaon the Spinal Evoked Potential 101
TraumaticBrain Injury
Adelson, P. D., Whalen, M. J., Kochanek, P. M., Robichaud, P., Carlos, T M.:
BloodBrainBarrierPermeability and Acute Inflammation in TwoModels ofTraumatic Brain Injury
in the ImmatureRat: A Preliminary Report 104
Baethmann, A., Lehr, D., Wirth, A., andStudy Group:
ProspectiveAnalysis ofPatient Managementin Severe HeadInjury .............................. 107
Bruzzone, P., Dionigi, R., Bellinzona, G., Imberti, R., Stocchetti, N:
Effects ofCerebral Perfusion Pressure on Brain Tissue P0 in Patients with Severe Head Injury III
2
Kroppenstedt, S.-N, Schneider, G.-H, Thomale, U-w., Unterberg, A. W.:
NeuroprotectiveProperties ofAptiganel HCI (Cerestat®) Following ControlledCortical Impact Injury 114
McKeating, E. G., Andrews, P. J. D., Mascia, L.:
RelationshipofNeuron Specific Enolase and Protein S-100Concentrations in Systemic andJugular
Venous Serum to Injury Severity and Outcome afterTraumatic Brain Injury ....................... 117
Mori, T, Kawamata, T, Katayama, Y., Maeda, T, Aoyama, N, Kikuchi, T, Uwahodo, Y.:
Antioxidant, OPC-14117, Attenuates EdemaFormation, and SubsequentTissue Damage Following
Cortical Contusion in Rats ... ............................................................ 120
Prat, R., Markiv, V., Dujovny, M., Misra, M.:
FailureofCerebral Autoregulation in an Experimental Diffuse BrainInjury Model 123
c.:
Schroder, M. L., Muizelaar, J. P., Fatouros, P., Kuta, J. A., Choi, S.
EarlyCerebral Blood Volume afterSevere Traumatic Brain Injury in Patients with Early Cerebral
Ischemia 127
Schwab, S., Schwarz, S., Aschoff, A., Keller, E., Hacke, w.:
ModerateHypothermiaand BrainTemperature in Patients with Severe Middle Cerebral Artery
Infarction 131
Thomas, S., Tabibnia, F., Schuhmann, M. U, Hans, V. H J., Brinker, T, Samii, M.:
Traumatic BrainInjury in the Developing Rat Pup: Studies ofICP, PVI and Neurological Response .... 135
XII Contents
Woischneck, Do, Firsching, R.:
Efficiency ofthe Glasgow Outcome Scale (GOS)-Score for the Long-Term Follow-Up afterSevere
BrainInjuries . 138
0 •• 0 •• 0 •• 0 •• 0 •• 0 0 •• 0 •• 0 ••••• 0 •• 0 •• 0 •• 0 •• 0 0 • 0 0 0 0 • 0 0 •• 0 •• 0 •• 0 ••••••••••• 0 0
Yunoki, M., Kawauchi, M., Ukita, N, Noguchi, Y., Nishio, S., Ono, Y., Asari, S., Ohmoto, T., Asanuma, M.,
Ogawa, N:
Effects ofLecithinized SOD on Sequential Change in SOD Activity afterCerebral Contusion in Rats 142
Poon, W. So, Ng, So, Wai, So:
CSFAntibiotic Prophylaxis for Neurosurgical Patients with Ventriculostomy: ARandomised Study 146
000.
Beaumont, A., Marmarou, Ao:
TheEffectofCorticotrophin Releasing Factoron the Formation ofPost-Traumatic Cerebral Edema .... 149
BrainOxygenMonitoring
w.,
Bardt, T. F., Unterberg, A. Hartl, R., Kiening, K L., Schneider, G.-H., Lanksch, W. R.:
MonitoringofBrainTissue POz in Traumatic BrainInjury: EffectofCerebral Hypoxiaon Outcome 153
Burger, R., Vince, G. H., Meixensberger, J., Roosen, K:
BilateralMonitoringofCBF and TissueOxygen Pressure in the PenumbraofaFocal Mass Lesion
in Rats 157
0 • 0 0 • 0 0 0 0 • 0 • 0 •• 0 •• 0 •• 0 •• 0 •• 0 •• 0 • 0 0 ••••• 0 •• 0 •• 0 0 • 0 •• 0 • 0 0 • 0 •• 0 • 0 •• 0 • 0 • 0 0 • 0 ••• 0 • 0 0
Stocchetti, N, Chieregato, Ao, De Marchi, M., Croci, M., Benti, R., Grimoldi, N:
HighCerebral PerfusionPressure Improves Low Values ofLocalBrainTissueOz Tension (PtiOz)
inFocal Lesions 162
0 •••••••••• 0 0 • 0
Doppenberg, E. M. R., Zauner, A., Watson, J. C, Bullock, R.:
Determination ofthe IschemicThreshold for Brain OxygenTension 166
Holzschuh, M., Metz, C, Woertgen, C, Rothorl, R. D., Brawanski, A.:
BrainIschemiaDetected by Tissue-POzMeasurementand the Lactate-Oxygen Index in HeadInjury 170
w.,
Kiening, K L., Schneider, G.-H., Bardt, T. F., Unterberg, A. Lanksch, W. R.:
BifrontalMeasurements ofBrain Tissue-POzin ComatosePatients 172
0 0 • 0 • 0 •• 0 • • • • • • • • ••
Lewis, S., Wong, M., Myburgh, J., Reilly, Po:
DeterminingCerebral Perfusion PressureThresholds in SevereHeadTrauma 174
McKinley, B. A., Parmley, C L.:
Effects ofInjury and Therapy on Brain Parenchyma pOz, pCOz,pH and ICPFollowing Severe Closed
HeadInjury .. o. 177
0 •• 0 • 0 • 0 0 •••• 0 • 0 0 •• 0 •• 0 •• 0 •••••••••••••••• 0 0 • 0 0 ••••••••••••••••••••• 0 • 0
Menzel, M., Rieger, A., Roth, S., Soukup, J., Peuse, C, Hennig, C, Molnar, P., Furka, I., Radke, J.:
Simultaneous Continuous MeasurementofpOz, pCOz,pH and Temperature in BrainTissueand
SagittalSinus in aPorcineModel .. 183
0 • 0 0 • 0 •• 0 0 • 0 •••••••••••••• 0 0 • 0 •• 0 •••••••••••••••••• 0 0 ••
w.,
Sarra/zadeh, A. So, Kiening, K L., Bardt, T. F., Schneider, G.-H., Unterberg, A. Lanksch, W. R.:
Cerebral Oxygenation in Contusioned vs. NonlesionedBrainTissue: Monitoring ofPtiOzwith Licox
and Paratrend o. 186
0 •••••••••••••••••••• 0 0 •• 0 • 0 •••••••••••••• 0 0 • 0 • 0 0 ••••••••••••••••• 0 • 0 • 0
van den Brink, W. A., van Santbrink, H., Avezaat, C J. J., Hogesteeger, C, Jansen, W., Kloos, L. M. H.,
Vermeulen, J., Maas, A. I. R.:
MonitoringBrain Oxygen Tension in Severe Head Injury: The Rotterdam Experience 190
.0 ••••••••••• 0.