Neuromonitoring bei erhöhtem intrakraniellen Druck

J. Meixensberger; M. Jaeger

doi:10.1055/s-2002-32028

Aktuelle Neurologie, Table of Contents

Aktuelle Neurologie 2002; 29(5): 235-241
DOI: 10.1055/s-2002-32028

Übersicht

Neuromonitoring bei erhöhtem intrakraniellen Druck

Neuromonitoring on Increased Intracranial PressureJ. Meixensberger¹ , M. Jaeger¹

¹Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig

Abstract

Zusammenfassung

Das Ausmaß des sekundären Hirnschadens, der nach einer akuten Erkrankung des Gehirns auftritt, ist wesentlich für das klinische Ergebnis verantwortlich. Die Methoden des erweiterten Neuromonitorings bieten die Möglichkeit der frühzeitigen Erkennung von derartigen sekundären hypoxischen und ischämischen Ereignissen. Ergänzend zur kontinuierlichen Erfassung des intrakraniellen Drucks bieten die Bulbus-jugularis-Oxymetrie, die Messung des Sauerstoffpartialdrucks im Hirngewebe und die Nah-Infrarot-Spektroskopie Informationen über die zerebrale Oxygenation. Die zerebrale Mikrodialyse erlaubt Einblicke in den Hirnstoffwechsel. Wir möchten einen Überblick über die gängigen Techniken des erweiterten Neuromonitorings geben und deren diagnostischen und therapeutischen Nutzen besprechen.

Abstract

Secondary neuronal damage caused by cerebral hypoxia and ischemia following acute brain disease is a major determinant of patient outcome. Advanced neuromonitoring allows early detection of such insults. In addition to continuous intracranial pressure monitoring, methdods such as jugular bulb oximetry, partial brain tissue oxygen pressure, and near-infrared spectroscopy provide information regarding cerebral oxygenation. Cerebral microdialysis gives insight into brain metabolism. Here, we summarise the currently available techniques in advanced neuromonitoring and discuss their diagnostic and therapeutic value.

Full Text

References

Literatur

1 Chesnut R M, Marshall L F, Klauber M R. et al . The role of secondary brain injury in determining outcome from severe brain injury. J Trauma. 1993; 34 216-222
2 Marmarou A, Anderson R L, Ward J D. et al . Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg. 1991; 75 S 59-S 66
3 Bouma G J, Muizelaar J P, Choi S C. et al . Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg. 1991; 75 685-693
4 Rosner M J, Rosner S D, Johnson A H. Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg. 1995; 83 949-962
5 Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand. 1960; 149, Suppl 1-193
6 Raabe A, Totzauer R, Meyer O. et al . Reliability of Epidural Pressure Measurement in Clinical Practice: Behavior of Three Modern Sensors during Simultaneous Ipsilateral Intraventricular or Intraparenchymal Pressure Measurement. Neurosurgery. 1998; 43 306-311
7 Bruder N, N'Zoghe P, Graziani N. et al . A comparison of extradural and intraparenchymatous intracranial pressure in head injured patients. Intensive Care Med. 1995; 21 850-852
8 Aschoff A, Steiner T. Messung von Hirndruck und Perfusionsdruck. In: Schwab S, Krieger D, Müllges W, Hamann G, Hacke W (Hrsg) Neurologische Intensivmedizin. Berlin, Heidelberg, New York; Springer-Verlag 1999: 271-303
9 Kerr E M, Marion D, Sereika M S. et al . The effect of cerebrospinal fluid drainage on cerebral perfusion in traumatic brain injured adults. J Neurosurg Anesthesiol. 2000; 12 324-333
10 Papo I, Caruselli G, Luongo A. CSF withdrawal for the treatment of intracranial hypertension in acute headinjuries. Acta Neurochir (Wien). 1981; 56 191-199
11 Sahuquillo J, Poca M A, Arribas M. et al . Interhemispheric supratentorial intracranial pressure gradients in head-injured patients: are they clinically important?. J Neurosurg. 1999; 90 16-26
12 Chambers I R, Kane P J, Signorini D F. et al . Bilateral ICP monitoring: its importance in detecting the severity of secondary insults. Acta Neurochir Suppl (Wien). 1998; 71 42-43
13 Burger R, Hassler W, Meixensberger J, Roosen K. Transcranial Doppler in Patients after Severe Head Injury: Correlation of Flow Velocity, Cerebral Blood Flow, Intracranial Pressure and CCT Findings. Anaest Intens Notfallmed. 1994; 43 289-297
14 Firsching R, Schütze M, Motschmann M, Behrens-Baumann W. Venous ophthalmodynamometry: a noninvasive method for assessment of intracranial pressure. J Neurosurg. 2000; 93 33-36
15 Maas A IR, Dearden N M, Teasdale G M. et al . EBIC-Guidelines for Management of Severe Head Injury in Adults. Acta Neurochir (Wien). 1997; 139 286-294
16 The Brain Trauma Foundation, The American Association of Neurological Surgeons Joint Section on Neurotrauma and Critical Care . Management and Prognosis of Severe Traumatic Brain Injury. J Neurotrauma. 2000; 17 449-554
17 Procaccio F, Stocchetti N, Citerio G. et al . Guidelines for the treatment of adults with severe head trauma. J Neurosurg Sci. 2000; 44 1-18
18 Teasdale G, Jennett B. Assessment of coma and impaired consciousness: A practical scale. Lancet. 1974; 13 81-84
19 Narayan R K, Kishore P R, Becker D P. et al . Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg. 1982; 56 650-659
20 Marshall L F, Marshall S B, Klauber M R, van Berkum C M. A new classification of head injury based on computerized tomography. J Neurosurg. 1991; 75 S 14-S 20
21 Eisenberg H M, Frankowski R F, Contant C F. et al . High-dose barbiturates control elevated intracranial pressure in patients with severe head injury. J Neurosurg. 1988; 69 15-23
22 Schwab S, Aschoff A, Spranger M. et al . The value of intracranial pressure monitoring in acute hemispheric stroke. Neurology. 1996; 47 393-398
23 Schwab S, Schellinger P, Aschoff A. et al . Epidural cerebrospinal fluid pressure measurement and therapy of intracranial hypertension in „malignant” middle cerebral artery infarct. Nervenarzt. 1996; 67 659-666
24 Janny P, Colnet G, Georget A M, Chazal J. Intracranial pressure with intracerebral hemorrhages. Surg Neurol. 1978; 10 371-375
25 Papo I, Janny P, Caruselli G. et al . Intracranial pressure time course in primary intracerebral hemorrhage. Neurosurgery. 1979; 4 504-511
26 Nakayama K, Miyasaka Y, Sato K. et al . Postoperative intracranial pressure in severe cases with hypertensive intracerebral hematoma. No To Shinkei. 1989; 41 1149-1154
27 Meixensberger J. Xenon 133-CBF Measurements in Severe Head Injury and Subarachnoid Haemorrhage. Acta Neurochir (Wien). 1993; 59, Suppl 28-33
28 Gopinath S P, Robertson C S, Contant C F. et al . Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry. 1994; 57 717-723
29 Valadka A B, Gopinath S P, Contant C F. et al . Relationship of brain tissue PO₂ to outcome after severe head injury. Crit Care Med. 1998; 26 1576-1581
30 Andrews P JD, Dearden N M, Miller J D. Jugular bulb cannulation: Description of a cannulation technique and validation of a new continuous monitor. Br J Anaesth. 1991; 67 553-558
31 Gibbs E L, Lennox W G, Nims L F. et al . Arterial and cerebral venous blood: Arterial-venous differences in man. J Biol Chem. 1942; 144 325-332
32 Sheinberg M, Kanter M J, Robertson C S. et al . Continuous monitoring of jugular venous oxygen saturation in head-injured patients. J Neurosurg. 1992; 76 212-217
33 Meixensberger J, Dings J, Jäger A. et al . Metabolisches Monitoring: Ersetzt die Gewebe-pO₂-Messung die Bestimmung der jugularvenösen Sauerstoffsättigung?. Anästhesiol Intensivmed Notfallmed Schmerzther. 1999; 34 S 48-S 53
34 Kiening K L, Unterberg A W, Bardt T F. et al . Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO₂ versus jugular vein oxygen saturation. J Neurosurg. 1996; 85 751-757
35 Latronico N, Beindorf A E, Rasulo F A. et al . Limits of Intermittent Jugular Bulb Oxygen Saturation Monitoring in the Management of Severe Head Trauma Patients. Neurosurgery. 2000; 46 1131-1139
36 Coplin W M, O'Keefe G E, Grady M S. et al . Thrombotic, Infectious, and Procedural Complications of the Jugular Bulb Catheter in the Intensive Care Unit. Neurosurgery. 1997; 41 101-109
37 Stocchetti N, Paparella A, Bridelli F. et al . Cerebral Venous Oxygenation Saturation Studied with Bilateral Samples in the Internal Jugular Veins. Neurosurgery. 1994; 34 38-44
38 Robertson C S, Narayan R K, Gokaslan Z. et al . Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg. 1989; 70 222-230
39 Cruz J, Hoffstad O J, Jaggi J L. Cerebral lactate-oxygen index in acute brain injury with acute anemia: assessment of false versus true ischemia. Crit Care Med. 1994; 22 1465-1470
40 Dings J, Meixensberger J, Jäger A, Roosen K. Clinical Experience with 118 Brain Tissue Oxygen Partial Pressure Catheter Probes. Neurosurgery. 1998; 43 1082-1095
41 van Santbrink H, Maas A IR, Avezaat C JJ. Continuous Monitoring of Partial Pressure of Brain Tissue Oxygen in Patients with Severe Head Injury. Neurosurgery. 1996; 38 21-31
42 Dings J, Meixensberger J, Roosen K. Brain tissue pO₂-monitoring: catheterstability and complications. Neurol Res. 1997; 19 241-245
43 Meixensberger J, Dings J, Kuhnigk H, Roosen K. Studies of Tissue PO₂ in Normal and Pathological Human Brain Cortex. Acta Neurochir (Wien). 1993; 59, Suppl 58-63
44 Väth A, Meixensberger J, Dings J, Roosen K. Advanced neuromonitoring including cerebral tissue oxygenation and outcome after traumatic brain injury. Neurol Res. 2001; 23 315-320
45 Väth A, Meixensberger J, Dings J. et al . Prognostic significance of advanced neuromonitoring after traumatic brain injury using neural networks. Zentralbl Neurochir. 2000; 61 2-6
46 van den Brink W A, van Santbrink H, Steyerberg E W. et al . Brain Oxygen Tension in Severe Head Injury. Neurosurgery. 2000; 46 868-878
47 Al-Rawi P G, Hutchinson P JA, Gupta A K. et al . Multiparameter brain tissue monitoring - Correlation between parameters and identification of CPP thresholds. Zentralbl Neurochir. 2000; 61 74-79
48 Menzel M, Doppenberg E MR, Zauner A. et al . Increased inspired oxygen concentration as a factor in improved brain tissue oxygenation and tissue lactate levels after severe human head injury. J Neurosurg. 1999; 91 1-10
49 Hutchinson P JA, Al-Rawi P G, O'Connell M T. et al . Head injury monitoring using cerebral microdialysis and Paratrend multiparameter sensors. Zentralbl Neurochir. 2000; 61 88-94
50 Büchner K, Meixensberger J, Dings J, Roosen K. Near-infrared spectroscopy - not useful to monitor cerebral oxygenation after severe head injury. Zentralbl Neurochir. 2000; 61 69-73
51 Kirkpatrick P J, Smielewski P, Czosnyka M. et al . Near-infrared spectroscopy use in patients with head injury. J Neurosurg. 1995; 83 963-970
52 Lewis S B, Myburgh J A, Thornton E L, Reilly P L. Cerebral oxygenation monitoring by near-infrared spectroscopy is not clinically useful in patients with severe closed head injury: A comparison with jugular venous bulb oximetry. Crit Care Med. 1996; 24 1334-1338
53 Kuebler W M, Sckell A, Habler O. et al . Noninvasive Measurement of Regional Cerebral Blood Flow by Near-Infrared Spectroscopy and Indocyanine Green. J Cerebral Blood Flow Metab. 1998; 18 445-456
54 Keller E, Wolf M, Martin M, Yonekawa Y. Estimation of Cerebral Oxygenation and Hemodynamics in Cerebral Vasospasm Using Indocyaningreen Dye Dilution and Near Infrared Spectroscopy. J Neurosurg Anesthesiol. 2001; 13 43-48
55 Goodman J C, Valadka A B, Gopinath S P. et al . Extracellular lactate and glucose alterations in the brain after injury measured by microdialysis. Crit Care Med. 1999; 27 1965-1973
56 Zauner A, Doppenberg E MR, Woodward J J. et al . Continuous Monitoring of Cerebral Substrate Delivery and Clearance: Initial Experience in 24 Patients with Severe Acute Brain Injuries. Neurosurgery. 1997; 41 1082-1093
57 Bullock R, Zauner A, Woodward J J. et al . Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg. 1998; 89 507-518
58 Hillered L, Valtysson J, Enblad P, Persson L. Interstitial glycerol as a marker for membrane phospholipid degradation in the acutely injured human brain. J Neurol Neurosurg Psychiatry. 1998; 64 486-491
59 Vespa P, Prins M, Ronne-Engstrom E. et al . Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg. 1998; 89 971-982
60 Unterberg A W, Sakowitz O W, Sarrafzadeh A S. et al . Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2001; 94 740-749
61 Meixensberger J, Kunze E, Barcsay E. et al . Clinical cerebral microdialysis: brain metabolim and brain tissue oxygenation after acute brain injury. Neurol Res. 2001; 23 801-806
62 Saul T G, Tucker T B. Effects of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg. 1982; 56 498-503
63 Colohan A R, Alves W M, Gross C R. et al . Head injury mortality in two centers with different emergency medical services and intensive care. J Neurosurg. 1989; 71 202-207
64 Robertson C S, Valadka A B, Hannay H J. et al . Prevention of secondary ischemic insults after severe head injury. Crit Care Med. 1999; 27 2086-2095

Prof. Dr. med. J. Meixensberger

Klinik und Poliklinik für Neurochirurgie · Universitätsklinikum Leipzig AöR

Johannisallee 34

04103 Leipzig

Email: meix@medizin.uni-leipzig.de