• Andrey Oshorov, Andrey Gavrjushin, Ivan Savin, Evgenia Alexandrova, and Denis Bragin.
• Burdenko Neurosurgery Institute, 4-Ya Tverskaya-Yamskaya Str, 16, Moscow, Russia, 125047. agvan2@nsi.ru.
• Neurocrit Care. 2023 Oct 1; 39 (2): 419424419-424.

IntroductionCerebral autoregulation is an essential mechanism for maintaining cerebral blood flow stability. The phenomenon of transtentorial intracranial pressure (ICP) gradient after neurosurgical operations, complicated by edema and intracranial hypertension in the posterior fossa, has been described in clinical practice but is still underinvestigated. The aim of the study was to compare autoregulation coefficients (i.e., pressure reactivity index [PRx]) in two compartments (infratentorial and supratentorial) during the ICP gradient phenomenon.MethodsThree male patients, aged 24 years, 32 years, and 59 years, respectively, were involved in the study after posterior fossa surgery. Arterial blood pressure and ICP were invasively monitored. Infratentorial ICP was measured in the cerebellar parenchyma. Supratentorial ICP was measured either in the parenchyma of the cerebral hemispheres or through the external ventricular drainage. Cerebral autoregulation was evaluated by the PRx coefficient (ICM + , Cambridge, UK).ResultsIn all patients, ICP was higher in the posterior fossa, and the transtentorial ICP gradient in each patient was 5 ± 1.6 mm Hg, 8.5 ± 4.4 mm Hg, and 7.7 ± 2.2 mm Hg, respectively. ICP in the infratentorial space was 17 ± 4 mm Hg, 18 ± 4.4 mm Hg, and 20 ± 4 mm Hg, respectively. PRx values in the supratentorial and infratentorial spaces had the smallest difference (- 0.01, 0.02, and 0.01, respectively), and the limits of precision were 0.1, 0.2, and 0.1 in the first, second, and third patients, respectively. The correlation coefficient between the PRx values in the supratentorial and infratentorial spaces for each patient was 0.98, 0.95, and 0.97, respectively.ConclusionsA high degree of correlation was established between the autoregulation coefficient PRx in two compartments in the presence of transtentorial ICP gradient and persistent intracranial hypertension in the posterior fossa. Cerebral autoregulation, according to the PRx coefficient in both spaces, was similar.© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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