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PubMed1995

Intraoperative monitoring of intracranial pressure in five dogs with space-occupying intracranial lesions.

Five dogs with space-occupying intracranial lesions underwent lateral craniectomy. Brain tissue pressures, reflective of intracranial pressure, were monitored during the surgical procedure, using a fiberoptic intracranial pressure monitoring system. The intracranial pressure monitoring cable was placed superficially in brain parenchyma on the side contralateral to the primary lesion. Recordings were made continually throughout the surgical procedure. Each dog was treated preoperatively with mannitol, which caused a decrease in intracranial pressure prior to craniectomy in only those dogs that initially had high intracranial pressure. Complications associated with use of the fiberoptic intracranial monitoring system were not evident. Although absolute values for pressure varied, pressure trends were helpful in determining effects of surgical manipulations on intracranial pressure in these dogs.

Animals↗
PubMed2001

Purulent pansinusitis, orbital cellulitis and rhinogenic intracranial complications.

Objectives: Acute pansinusitis is rarely seen in the maxillofacial surgery field, but often occurs in combination with orbital and intracranial involvement. Clinically this entity is of great importance, since it represents a severe disease with possibly disastrous consequences. Patients: Aetiology, diagnosis and therapy of acute pansinusitis and its complications were analysed in 36 patients treated surgically from 1987 to 1996. Results: Eighteen patients were aged between 3 and 21-years-old. Only eight suffered from pure pansinusitis, and three of an isolated purulent orbital infection. Of these 25 patients 20 had (pan-)sinusitis with orbital, three with intracranial, and two with both orbital and intracranial complications. Intracranial involvement included meningitis, empyema and brain abscess. Aetiology was rhinogenic in 26, odontogenic in six patients, and traumatic in two cases. Radiological work-up included conventional radiographs and CT in most cases, MRI was only used with special indications. Microbiological examination detected single or multiple species of micro-organisms with equal frequency. If multiple species were found, infection was mostly aerobic/anaerobic in combination. Conclusion: These purulent processes, frequently seen in young patients, require immediate surgical intervention and drainage with elimination of the cause of the disease if possible. Cooperation with other specialities is essential depending on the spread of the disease. In spite of the threatening acute symptoms, severe courses of disease or permanent defects should be avoidable. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗
PubMed1982

Changes of intracranial pressure during the rupture of intracranial aneurysms: prognosis for survival.

The intracranial pressure at the time of rebleeding from an intracranial aneurysm was recorded in 4 patients who were undergoing conservative treatment pending clinical improvement. Two died of severe hemorrhages and the remaining two recovered. In the deceased patients, repeated rapid increases in the intracranial pressure in a short time caused by rupture of the intracranial aneurysm were observed. In the surviving patients, the intracranial pressure increased only once, owing to the rupture of the intracranial aneurysm. We suggest that sudden death following the rupture of an intracranial aneurysm may result from frequent, repeated bleeding causing an intracerebral hematoma or severe brain swelling, or both.

Adult↗
PubMed1999

Transcranial Doppler monitoring compared with invasive monitoring of intracranial pressure during acute intracranial hypertension.

OBJECTIVE: To determine whether a simple transcanial Doppler waveform variable-pulsatility difference (systolic - diastolic blood flow velocity) can serve as a measure of critical changes in cerebral perfusion. METHODS: Thirteen pigs were anesthetized (anesthesia maintained with halothane) and ventilated to maintain normoxia and normocarbia. To measure mean arterial pressure, hemoglobin, and blood gases, the right carotid artery was cannulated. The right intracranial lateral ventricle was cannulated to measure and increase intracranial pressure; the right internal jugular vein was cannulated in 8 of 13 pigs to measure jugular venous oxygen saturation and to calculate cerebral arteriovenous oxygen content difference. Intracranial pressure was also monitored continuously with a subdural bolt in the contralateral frontal region, and blood flow velocity in the middle cerebral artery was measured with a transcranial Doppler probe on the right orbital region. Intracranial pressure was increased in increments of 10 to 20 mmHg by infusing saline through the ventriculostomy catheter until the transcranial Doppler indicated that blood flow velocity had ceased, at which point all variables were allowed to return to baseline. If mean arterial pressure failed to return to baseline, epinephrine, 0.01 to 0.1 microg/kg/min, was infused. Useful data were obtained from 8 pigs and were analyzed separately for pigs that received epinephrine (n = 4) and those that did not (n = 4). RESULTS: Transcranial Doppler measurements correlated more closely with cerebral perfusion pressure = (mean arterial pressure - intracranial pressure) than with intracranial pressure. In the range of 30 to 60 mmHg, cerebral perfusion pressure correlated linearly with the pulsatility difference. The closest nonlinear correlation (third order polynomial relationship) was noted between cerebral perfusion pressure and pulsatility difference (r = 0.8, P < 0.001, n = 217), for the animals that did not receive epinephrine. When a cerebral perfusion pressure < 60 mmHg and a cerebral arteriovenous oxygen content difference > 6.5 vol% were used to define limits of abnormal, pulsatility difference was a sensitive and specific indicator of abnormality in either variable. Pulsatility difference of > 70 cm/sec had > 77.1% and 86.7% positive accuracy rate, and < 0% and 14.3% negative accuracy rate for abnormal cerebral perfusion pressure (CPP) and cerebral arterio-venous O2 (C[a-v]O2), respectively. CONCLUSIONS: In pigs with induced diffuse intracranial hypertension, noninvasive transcranial Doppler waveform monitoring of pulsatility difference can identify increased cerebral oxygen extraction and dangerously decreased cerebral perfusion pressure.

Acute Disease↗
PubMed2000

Cerebrovascular tone rather than intracranial pressure determines the effective downstream pressure of the cerebral circulation in the absence of intracranial hypertension.

Cerebral perfusion pressure is commonly calculated from the difference between mean arterial pressure and intracranial pressure because intracranial pressure is known to represent the effective downstream pressure of the cerebral circulation. Studies of other organs, however, have shown that effective downstream pressure is determined by a critical closing pressure located at the arteriolar level. This study was designed to investigate the effects of PCO2-induced variations in cerebrovascular tone on the effective downstream pressure of the cerebral circulation. Sixteen patients recovering from head injury were studied. Intracranial pressure was assessed by epidural pressure transducers. Blood flow velocity in the middle cerebral artery was monitored by transcranial Doppler sonography. Effective downstream pressure was derived from the zero flow pressure as extrapolated by regression analysis of instantaneous arterial pressure/middle cerebral artery flow velocity relationships. PaCO2 was varied between 30 and 47 mm Hg in randomized sequence. Intracranial pressure decreased from 18.5+/-5.2 mm Hg during hypercapnia to 9.9+/-3.1 mm Hg during hypocapnia. In contrast, effective downstream pressure increased from 13.7+/-9.6 mm Hg to 23.4+/-8.6 mm Hg and exceeded intracranial pressure at hypocapnic PaCO2 levels. Our results demonstrate that, in the absence of intracranial hypertension, intracranial pressure does not necessarily represent the effective downstream pressure of the cerebral circulation. Instead, the tone of cerebral resistance vessels seems to determine effective downstream pressure. This suggests a modified model of the cerebral circulation based on the existence of two Starling resistors in a series connection.

Adult↗
PubMed1983

Influence of urapidil on intracranial pressure and intracranial compliance in dogs.

During induced hypotension with urapidil, measurements of intracranial pressure and of the ventricular volume-pressure response (intracranial compliance) were obtained in dogs with and without intracranial hypertension. A bolus of urapidil 50 mg plus an infusion of urapidil 8.2 +/- 1.2 mg min-1 decreased mean arterial pressure by 22 +/- 10% from control in group I (without intracranial hypertension) and by 24 +/- 8% in group II (with intracranial hypertension). In both groups there was no change in intracranial pressure or in intracranial compliance after the administration of urapidil.

Animals↗
PubMed1999

Intracranial contrast-enhancing masses in infants with capillary haemangioma of the head and neck: intracranial capillary haemangioma?

Contrast-enhancing intracranial masses are rarely found in infants with extracranial capillary haemangiomas (CH). We aimed to assess their nature and progression in three patients undergoing CT and/or MRI. The changes in size of both extra- and intracranial lesions were recorded. In a fourth case, a single examination was obtained. All patients harboured one or two enhancing intracranial nodular, meningeal-based lesions. Diffuse leptomeningeal enhancement of the cerebellar surface was also seen in one, which disappeared at follow-up. In all but one of the cases, the intracranial lesions were on the same side as the extracranial CH. These lesions and the extracranial CH demonstrated parallel changes in size (suggesting that both represent CH) during follow-up of 1-2 years: the size of intracranial lesions and the extracranial CH decreased in two cases, whereas it was unchanged in the third. One patient had a persistent trigeminal artery, while another had cerebellar atrophy with high signal in the cortex on T2-weighted images. In some cases, extracranial CH are part of PHACE syndrome; the association with intracranial CH might represent a peculiar phenotype of this rare vascular phakomatosis. As extracranial CH are known to regress spontaneously in the majority of cases, a conservative approach is recommended also for presumed intracranial CH; surgery should be avoided unless follow-up studies demonstrate growth.

Female↗
PubMed1998

Do human intracranial arteries lack vasa vasorum? A comparative immunohistochemical study of intracranial and systemic arteries.

Vasa vasorum are adventitial vessels that play a role in pathogenesis of atherosclerosis, aneurysm, vasculitides, and graft vascular disease. The existence of vasa vasorum in human intracranial arteries is not yet well defined. The specific aims of this study are to determine whether the human intracranial arteries have vasa vasorum, whether their existence is related to the thickness of tunica media as is in systemic vessels, and whether they are acquired in reaction to pathological conditions, such as atherosclerosis and arterial occlusion. Human intracranial internal carotid (i-ICA), vertebral (i-VA), basilar (BA) and middle cerebral arteries (MCA) from adults, children and newborns were examined. Systemic vessels of comparable medial thickness were used as controls. Immunohistochemical staining for Factor VIII and CD 31 was used to identify the endothelial cells. Human intracranial arteries in neonates, children and adults do not have vasa vasorum, although their medial thickness is comparable to their systemic counterparts with vasa vasorum. Only in adults did the proximal intracranial segments of i-ICA and i-VA reveal a few vasa vasorum-like vessels with unusually large diameter. They were more frequently seen in atherosclerosis and thrombotic but again limited to the proximal segments of i-ICA and i-VA. Completely obstructed bilateral carotid arteries in a child with sickle cell disorder revealed a rich adventitial neovascularization in the proximal intracranial part of the vessel. It is not yet known whether obstruction of the distal segments may create similar neovascularizations. Adventitial neovascularizations seen in the proximal i-ICA and i-VA may represent a focal intracranial extension of the vascular pathologies involving the extracranial segments of major cerebral arteries.

Adolescent↗
PubMed1979

Intracranial compliance during the post-operative period after surgery for intracranial aneurysms.

Generalised post-operative cerebral vasospasm is a major factor in delineating poor operative results following direct ruptured intracranial aneurysms. Continuous monitoring of intracranial pressure seems to be particularly helpful on such occasions, and intracranial compliance determination as well. High intracranial compliance values suggest that even small intracranial volume increases may induce rapid intracranial pressure and situations likely to produce neurological deterioration.

Humans↗
PubMed2002

Extracranial-intracranial vein graft bypass for giant intracranial aneurysm surgery for pediatric patients: two technical case reports.

OBJECTIVE AND IMPORTANCE: Herein we describe two cases of extracranial-intracranial vein graft bypasses for the treatment of giant intracranial aneurysms in prepubertal pediatric patients. One patient is, we think, the youngest patient reported in the literature to have been successfully treated in such a manner, with a good long-term outcome. Such grafts seem to enlarge longitudinally during the growth spurt, making such techniques reasonable long-term therapeutic options for the management of complex intracranial aneurysms in pediatric patients. CLINICAL PRESENTATION: Patient 1, a 13-year-old boy, presented with headaches and rapidly progressive right cavernous sinus syndrome. Computed tomography and cerebral angiography revealed a giant, fusiform, right intracavernous internal carotid artery aneurysm. Patient 2, a 23-month-old girl, was discovered to harbor an asymptomatic, recurrent, giant, fusiform, left M1 middle cerebral artery aneurysm 1 year after presenting with seizures related to subarachnoid hemorrhage from the aneurysm, for which she had been treated with clipping and an M2-M2 anastomosis. INTERVENTION: Both patients underwent craniotomies, with sacrifice of the proximal parent vessel (the distal cervical internal carotid artery and the proximal middle cerebral artery, respectively), combined with cerebral revascularization through extracranial-intracranial saphenous vein bypass grafts. Both patients experienced excellent long-term clinical outcomes, have undergone significant growth, and exhibit excellent long-term graft patency and aneurysm obliteration. CONCLUSION: These two cases highlight the safety and efficacy of extracranial-intracranial vein graft bypasses among prepubertal pediatric patients. The indications for bypass procedures to treat giant intracranial aneurysms are discussed, and the technical aspects of maximizing vein bypass graft patency are reviewed.

Adolescent↗
PubMed1994

Effects of fenoldopam on intracranial pressure and hemodynamic variables at normal and elevated intracranial pressure in anesthetized pigs.

Fenoldopam (FE), a dopamine DA1-receptor agonist, has been introduced for treatment of arterial hypertension and heart failure and for preservation of renal function. Vasodilators are generally assumed to affect all vascular beds including the cerebral circulation. We have evaluated effects of FE-induced (4 micrograms.kg-1.min-1) arterial hypotension on intracranial pressure (ICP) and intraocular pressure (IOP) under conditions of normal and increased intracranial elastance. ICP and IOP responses to hypertension were tested by infusion of angiotensin II (15 micrograms.kg-1.min-1), and the response to hypercapnia was tested by elimination and reintegration of soda lime canisters in the breathing circuit. Intracranial elastance was increased by infusing mock cerebrospinal fluid (CSF) into the lateral ventricle (20 +/- 3 ml.h-1). Arterial hypotension induced with FE did not increase ICP. With increased intracranial elastance, the infusion rate of mock CSF had to be reduced while administering FE to avoid a rise in ICP (p < 0.05 compared with preinfusion value); this indicates a shift on the volume-pressure curve to the right. There were no indicators that cerebral autoregulation or CO2 reactivity of the cerebral vasculature were affected by FE in this anesthetized porcine model, as speculated from analysis of the time course of delta ICP. There are, however, indicators of increased intracranial elastance, most likely caused by vasodilation. Caution should hence be exercised when FE is administered to patients with increased intracranial elastance.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1989

Overnight recordings of intracranial pressure and electroencephalography in neurosurgical patients. Part I: Intracranial pressure waves and their clinical correlations.

Simultaneous overnight recordings of intracranial pressure (ICP) and electroencephalography (EEG) were conducted on 85 neurosurgical patients with intracranial hypertension and/or ventriculomegaly. Intracranial pressure waves were classified into five types according to the pattern of appearance, and their correlation with sleep cycles and clinical conditions of patients were investigated. A-waves appeared exclusively in patients with long-standing intracranial hypertension, and episodic B-waves appeared in patients with chronic hydrocephalus or a postoperative tumor-free condition. When these episodic pressure waves appeared, the patients were conscious and sleep cycles including REM stage were observed. Persistent, high pressure B-waves were seen mostly in patients with an acute phase of intracranial hemorrhages. The consciousness of these patients ranged from drowsy to stupor. EEG showed alternate appearances of light sleep and waking rhythms in accordance with cyclic oscillations of B-waves which coincided with periodic, apneic respiratory rhythms. When markedly regular B-waves of moderately high pressure appeared continuously, the patients were severely impaired in consciousness and were mainly in a subacute phase of intracranial hemorrhages. EEG showed continuous slow activities and sleep stages were not scored in these patients. No characteristic clinical features were found in patients whose ICP remained within normal range without pressure waves throughout the recording.

Adolescent↗
PubMed1992

[Intentional hypotension therapy induced by nitroglycerin and the changes in the intracranial pressure for acute hemorrhagic intracranial lesions].

It is reported that nitroglycerin (NTG) induces the elevation of intracranial pressure (ICP). Because of it, the use of NTG in patients exhibiting the increased ICP especially in the neurosurgical field is thought to be avoided. However, these reported cases dealt with normal patients. Few cases under the condition of exactly increased intracranial pressure were studied. Our 31 patients of the hemorrhagic intracranial lesion (subarachnoid hemorrhage and hypertensive intracranial hemorrhage) at the acute stage were treated by NTG infusion as an antihypertensive drug, and the ICP was measured using the epidural pressure transducer. The 31 patients were divided into three groups. Group 1 consists of the 14 patients exhibiting normal ICP (< 15mmHg). Group 2 consists of 9 patients showing elevated ICP (15mmHg < or =). Group 3 consists of 8 patients treated with glycerol before the NTG infusion. Group 1 demonstrates a statistically significant elevation of ICP corresponding with the blood pressure depression. Group 2 showed no significant elevation of it. Group 3 disclosed no remarkable elevation of it both in the elevated ICP cases and the normal ICP cases. As mentioned above, the intravenous NTG caused a remarkable increase of ICP in the normal compliance of the intracranial contents and no elevation of ICP in the poor compliance. We conclude that NTG can be used for blood pressure control at an acute stage even in hemorrhagic intracranial lesion as anti-depressor.

Acute Disease↗
PubMed1992

[Extending informative value of intracranial pressure measurement by cerebral pressure amplitudes (Pa)--analysis of average intracranial pressure (Pm)].

One aim of the intracranial pressure measurement is observing constantly patients with intracranial space-occupying factors and therefore to act diagnosticly and therapeutically correct at the right time. Through the continual registration of the intracranial pressure amplitude in relation to the medium intracranial pressure it is earlier possible to forecast intracranial pressure rise and to deal with this than with just the simple measurements of medium intracranial pressure. With 40 neurosurgical patients such examinations were undertaken after implantation of a ventricle catheter. The value of this method was proven during the continual observation of the patient.

Brain Injuries↗
PubMedDate not supplied

[Correction of intracranial pressure in patients with traumatic intracranial hemorrhages].

Therapeutical correction of intracranial pressure changes were conducted in 14 patients suffering from traumatic intracranial hematomas by endolumbar administration of physiological solution. The distinguishing feature of this method is the possibility of continuous control of the intracranial pressure level by means of long-term graphic recording of epidural pressure. This makes it possible to perform endolumbar administration of physiological solution in a dose which is determined by the initial level of epidural intracranial pressure. Therapeutic correction of intracranial pressure by endolumbar injection of physiological solution proved successful in the initial stages of dislocation of the brain and in stable intracranial hypotension.

Adult↗
PubMed1992

Effect of sevoflurane on intracranial pressure, sagittal sinus pressure, and the intracranial volume-pressure relation in cats.

The effect of sevoflurane on intracranial pressure (ICP), sagittal sinus pressure (SSP), and the intracranial volume-pressure (V-P) relation was examined in cats. In experiment 1, on nine cats, changes in ICP and SSP were studied for 180 min during anesthesia with 1 MAC sevoflurane (2.6%, inspired) and 50% nitrous oxide (N2O) in oxygen (O2). ICP significantly (p <0.01) increased from 8.4 +/- 3.8 cm H2O (mean +/- SD), the control level to 10.6 +/- 5.1 cm H2O immediately after the administration of sevoflurane. ICP was unchanged for the subsequent 120 min but then increased significantly (p <0.05) 140 min after administration, being 15.5 +/- 9.0 cm H2O at 180 min. There were no changes in SSP or blood gases. In experiment 2, the rapid injection technique of mock cerebrospinal fluid was used to determine the intracranial V-P relation in ten cats. Measures of V-P relationships included (a) ICP before volume injection (Po), (b) peak ICP caused by volume injection (Pp), (c) intracranial compliance (C) calculated as the ratio of change of intracranial volume Delta V) to change of ICP (Delta P), and (d) the pressure volume index (PVI) calculated as the ratio of Delta V to log Pp/Po. The subjects were divided into two groups, one administered 2.6% sevoflurane and 50% N2O in O2 (n = 6) and the other 50% N2O in O2 (n = 4). Each cat in both groups was given two bolus injections into the lateral ventricle at 180 min after the start of anesthesia. Then, C and PVI were calculated. C and PVI in the group treated with sevoflurane were significantly (p <0.05) lower than in the other group. These findings suggest that prolonged use of sevoflurane increases the intracranial elastance.

Journal Article↗
PubMed2003

Intracranial pressure monitoring and case mix-adjusted mortality in intracranial hemorrhage.

OBJECTIVE: Intracranial pressure (ICP) monitoring is frequently used in intensive care treatment of patients with intracranial hemorrhage. Data demonstrating an improved outcome from this intervention are lacking. We analyzed standardized mortality ratios in patients with and without ICP monitoring to determine its efficacy. DESIGN: A nonrandomized study of case records of consecutively admitted intensive care unit (ICU) patients with intracranial hemorrhage. SETTING: General and medical ICU of a 900-bed tertiary-care hospital. PATIENTS: A total of 225 patients with intracranial hemorrhage (mainly nontraumatic) admitted consecutively between April 1997 and March 2000. MEASUREMENTS: Simplified Acute Physiology Score (SAPS) II, diagnosis, age, sex, use of ICP monitoring, and in-hospital mortality rates were collected from the hospital's ICU database. Expected mortality was provided by means of SAPS II. Standardized mortality ratios were calculated and compared in 119 patients with ICP monitoring and 106 patients without ICP monitoring. MAIN RESULTS: The case mix-adjusted hospital mortality in the group with ICP monitoring was in the expected range (standardized mortality ratio, 1.09 [95% confidence interval (CI), 0.87-1.31]). Patients without ICP monitoring had a significantly higher standardized mortality ratio than expected (1.26 [95% CI, 1.06-1.46]). CONCLUSIONS: A beneficial effect of ICP monitoring in patients with intracranial hemorrhage may be reflected in an improved standardized mortality ratio.

APACHE↗