Percutaneous Implantation of Cerebral Microdialysis Catheters by Twist-Drill Craniostomy in Neurocritical Patients: Description of the Technique and Results of a Feasibility Study in 97 Patients

Poca, María; Sahuquillo, Juan; Vilalta, Anna; Ríos, Jorge De Los; Robles, Ángel; Expósito, L.

doi:10.1089/neu.2006.23.1510

Cited by 24 publications

(12 citation statements)

References 18 publications

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“…Brain microdialysis catheters are inserted into non-injured brain tissue according to a previously described methodology [23]. A CMA-70 brain microdialysis catheter with a 20-kDa cut-off membrane (MDialysis AB, Stockholm, Sweden) was used in 16 patients, and a CMA-71 catheter with a 100-kDa cut-off membrane (MDialysis AB, Stockholm, Sweden) was used in 30 patients.…”

Section: Methodsmentioning

confidence: 99%

Lactate and the Lactate-to-Pyruvate Molar Ratio Cannot Be Used as Independent Biomarkers for Monitoring Brain Energetic Metabolism: A Microdialysis Study in Patients with Traumatic Brain Injuries

et al. 2014

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BackgroundFor decades, lactate has been considered an excellent biomarker for oxygen limitation and therefore of organ ischemia. The aim of the present study was to evaluate the frequency of increased brain lactate levels and the LP ratio (LPR) in a cohort of patients with severe or moderate traumatic brain injury (TBI) subjected to brain microdialysis monitoring to analyze the agreement between these two biomarkers and to indicate brain energy metabolism dysfunction.MethodsForty-six patients with an admission Glasgow coma scale score of ≤13 after resuscitation admitted to a dedicated 10-bed Neurotraumatology Intensive Care Unit were included, and 5305 verified samples of good microdialysis data were analyzed.ResultsLactate levels were above 2.5 mmol/L in 56.9% of the samples. The relationships between lactate and the LPR could not be adequately modeled by any linear or non-linear model. Neither Cohen’s kappa nor Gwet’s statistic showed an acceptable agreement between both biomarkers to classify the samples in regard to normal or abnormal metabolism. The dataset was divided into four patterns defined by the lactate concentrations and the LPR. A potential interpretation for these patterns is suggested and discussed. Pattern 4 (low pyruvate levels) was found in 10.7% of the samples and was characterized by a significantly low concentration of brain glucose compared with the other groups.ConclusionsOur study shows that metabolic abnormalities are frequent in the macroscopically normal brain in patients with traumatic brain injuries and a very poor agreement between lactate and the LPR when classifying metabolism. The concentration of lactate in the dialysates must be interpreted while taking into consideration the LPR to distinguish between anaerobic metabolism and aerobic hyperglycolysis.

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Section: Methodsmentioning

confidence: 99%

Lactate and the Lactate-to-Pyruvate Molar Ratio Cannot Be Used as Independent Biomarkers for Monitoring Brain Energetic Metabolism: A Microdialysis Study in Patients with Traumatic Brain Injuries

et al. 2014

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“…While the frequency of haemorrhagic and infectious complications in patients with multimodality monitoring is low (63), the amount of MD catheters that either become dysfunctional for unknown reasons or that are unintentionally removed due to the everyday care is fairly high (>10% in selected studies) (64,65). The care provided in the NCCU requires patient turning, hoisting and transfer to neuroimaging, which may all result in unintentional MD catheter removal.…”

Section: Challenges In Clinical MD Metabolic Monitoringmentioning

confidence: 99%

Microdialysis Monitoring in Clinical Traumatic Brain Injury and Its Role in Neuroprotective Drug Development

Thelin

Carpenter

Hutchinson

et al. 2017

AAPS J

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Abstract.Injuries to the central nervous system continue to be vast contributors to morbidity and mortality; specifically, traumatic brain injury (TBI) is the most common cause of death during the first four decades of life. Several modalities are used to monitor patients suffering from TBI in order to prevent detrimental secondary injuries. The microdialysis (MD) technique, introduced during the 1990s, presents the treating physician with a robust monitoring tool for brain chemistry in addition to conventional intracranial pressure monitoring. Nevertheless, some limitations remain, such as limited spatial resolution. Moreover, while there have been several attempts to develop new potential pharmacological therapies in TBI, there are currently no available drugs which have shown clinical efficacy that targets the underlying pathophysiology, despite various trials investigating a plethora of pharmaceuticals. Specifically in the brain, MD is able to demonstrate penetration of the drug through the blood-brain barrier into the brain extracellular space at potential site of action. In addition, the downstream effects of drug action can be monitored directly. In the future, clinical MD, together with other monitoring modalities, can identify specific pathological substrates which require tailored treatment strategies for patients suffering from TBI.

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“…In a study of 97 patients .. .............................................................................................................................................. using 122 implanted cerebral microdialysis catheters during treatment of cerebral injuries, no device-related infections were registered. 29 Microdialysis combines significantly less invasiveness with continuous sampling in the same individual compared with single tissue biopsies representing a static condition. 21 In orthopaedic research evaluating the antibiotic concentration in bone, microdialysis has been suggested as a superior alternative to bone biopsies.…”

Section: Discussionmentioning

confidence: 99%

Microdialysis as a method for biochemical and physiological studies of the porcine and human disc

Liljensten¹,

Skog²,

Sönnergren³

et al. 2010

Lab Anim

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At present, no minimally invasive technique exists for the continuous evaluation of the biochemistry of animal and human intervertebral discs, but for research purposes microdialysis may be such a new technique. Thus, the aims of this study were to (1) evaluate if microdialysis can be used successfully in lumbar porcine disc and (2) develop a suitable procedure for the application of microdialysis in the human disc. Conventional specific pathogen-free pigs were used to evaluate cannulation (n ¼ 2) and then insertion of a 10 mm microdialysis membrane, including recovery of a dialysate from the nucleus pulposus (n ¼ 6). The procedure was performed immediately after euthanasia and aided by fluoroscopy to guide the needle and confirm catheter placement. Access to lumbar porcine disc was obtained with an 18 G 2 in. needle applied at a 35-458 angle from the sagittal plane, and took less than 8 min to perform. At a 0.5 mL/min flush rate, dialysates could be recovered and analysable amounts of glucose, lactate and pyruvate were obtained. In one human cadaver, the L4-L5 disc was accessed by a 19 G 3 in. needle inserted at a 35-408 angle. It was possible to apply 10 mm as well as 30 mm microdialysis membranes in the nucleus. In both species the position of the membranes was verified by direct fluoroscopy and with contrast fluid. The results obtained from porcine and human cadavers are promising, and encourage further in vivo studies using microdialysis technique on intervertebral discs.

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Percutaneous Implantation of Cerebral Microdialysis Catheters by Twist-Drill Craniostomy in Neurocritical Patients: Description of the Technique and Results of a Feasibility Study in 97 Patients

Cited by 24 publications

References 18 publications

Lactate and the Lactate-to-Pyruvate Molar Ratio Cannot Be Used as Independent Biomarkers for Monitoring Brain Energetic Metabolism: A Microdialysis Study in Patients with Traumatic Brain Injuries

Lactate and the Lactate-to-Pyruvate Molar Ratio Cannot Be Used as Independent Biomarkers for Monitoring Brain Energetic Metabolism: A Microdialysis Study in Patients with Traumatic Brain Injuries

Microdialysis Monitoring in Clinical Traumatic Brain Injury and Its Role in Neuroprotective Drug Development

Microdialysis as a method for biochemical and physiological studies of the porcine and human disc

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