Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2012
Randomized Controlled TrialA microdialysis study of oral vigabatrin administration in head injury patients: preliminary evaluation of multimodality monitoring.
We assessed the feasibility of administering a neuroprotective drug, vigabatrin (VGB; gamma-vinyl-gamma-aminobutyric acid) with multimodality monitoring, including cerebral microdialysis, in severe head injury patients, to measure surrogate endpoints and blood-brain barrier (BBB) penetration. ⋯ Multimodality monitoring, including cerebral microdialysis, is feasible for studying surrogate endpoints following drug administration. VGB crosses the BBB, leading to modest increases in extracellular GABA. Further analyses are ongoing. Microdialysis may assist the development of neuroprotective agents by determining penetration into extracellular fluid of the brain.
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Acta Neurochir. Suppl. · Jan 2012
Near infrared spectroscopy as possible non-invasive monitor of slow vasogenic ICP waves.
We aimed to study synchronisation between ICP and near infrared spectroscopy (NIRS) variables induced by vasogenic waves of ICP during an infusion study in hydrocephalic patients and after TBI. Nineteen patients presenting with hydrocephalus underwent a diagnostic intraventricular constant-flow infusion test. The original concept of the methodology, presented in the current paper, was derived from this material. ⋯ Fluctuations of Hb and HbO(2) at baseline negatively correlated with each other, but switched to high positive values during periods of increased ICP slow-wave activity during infusion (p < 0.001). Similar behaviour was observed in TBI patients: baseline negative Hb/HbO(2) correlation changed to positive values during peaks of ICP of vasogenic nature. Correlating changes in Hb and HbO(2) may be of use as a method of non-invasive detection of vasogenic ICP waves.
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Acta Neurochir. Suppl. · Jan 2012
Bedside study of cerebral critical closing pressure in patients with severe traumatic brain injury: a transcranial Doppler study.
Cerebral critical closing pressure (CrCP) is the arterial pressure (AP) below which small arterial cerebral vessels collapse. Our objective was to estimate cerebral CrCP in 12 severe TBI patients, relating transcranial Doppler flow velocity (FV) and AP data. ⋯ The frequently found negative values do not allow us for the moment, to use any of these three methods for clinical guidance.
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Acta Neurochir. Suppl. · Jan 2012
Shunt-dependent hydrocephalus following subarachnoid hemorrhage correlates with increased S100B levels in cerebrospinal fluid and serum.
Posthemorrhagic hydrocephalus requiring permanent ventriculoperitoneal shunt placement is a major complication of aneurysmal subarachnoid hemorrhage (SAH). High S100B serum and cerebrospinal fluid (CSF) levels are considered to reflect the severity of brain injury. We prospectively assessed whether S100B levels in serum and CSF were predictive parameters for permanent shunt requirement following aneurysmal SAH. ⋯ Out of 68 patients included in the study, 43 patients (63.2%) passed the EVD challenge and in 25 patients (36.8%) permanent ventriculoperitoneal shunting was performed. Group comparison revealed that in patients who required shunt placement, S100B was significantly higher in CSF (p < 0.05 at days 2, 4, 6, 10; p < 0.005 at days 1, 3, 5, 7, 8, 9) and serum (p < 0.05 at days 4-7) compared with patients who could be weaned from the EVD. Assessment of S100B levels in CSF and serum may be useful as a predictive parameter for shunt dependency in patients with posthemorrhagic hydrocephalus following aneurysmal SAH.
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Acta Neurochir. Suppl. · Jan 2012
Telemetric ICP measurement with the first CE-approved device: data from animal experiments and initial clinical experiences.
The objective was to evaluate the qualification of the new telemetric intracranial pressure (ICP) measurement (t-ICP) device Raumedic(®) NEUROVENT P-Tel and S-Tel. The proof of concept was examined in a pilot animal study measuring intraperitoneal pressure with a telemetric and a conventional ICP measurement probe at five rates for 1 h each. Moderate external pressure load allowed measuring values between 0 and 40 mmHg. ⋯ Raumedic's NEUROVENT(®) P-Tel/S-Tel proved to provide reliable data over periods of up to 18 months. Minor zero drift can be well tolerated as the dynamic ICP signal is measured with excellent stability. Clinicians should focus more on such ICP dynamic signal information than on static ICP when using the device over longer follow-up periods.