Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage

Vajkoczy, Peter; Horn, Peter A.; Thomé, Claudius; Münch, Elke; Schmiedek, Peter

doi:10.3171/jns.2003.98.6.1227

Cited by 191 publications

(114 citation statements)

References 26 publications

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“…Thermal diffusion flowmetry is so far the only technique, which allows for CBF monitoring in a feasible and user-friendly way directly at the bedside and there is evidence that symptomatic vasospasm after aSAH can be detected by the method 7,8 . However, its clinical application is limited because measurement drifts have been reported over the 30-minute measurement cycle and between automatically performed recalibrations 23 .…”

Section: Discussionmentioning

confidence: 99%

“…In 2000, thermal diffusion flowmetry for continuous bedside assessment of CBF was introduced and potential clinical benefits were demonstrated in patients with symptomatic vasospasm after aSAH 7,8 . However, the clinical application remains limited because of reduced reliability of CBF measurements in patients with fever and hemodynamic instability 9 .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

et al. 2016

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Objective: To evaluate a brain tissue probe for intracranial pressure (ICP) and temperature (TEMP) monitoring as well as determination of cerebral hemodynamics using a near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution method (NIRS-ICP probe). Methods: The NIRS-ICP probe was applied after aneurysmal subarachnoid hemorrhage if multimodal monitoring was established due to poor neurological condition. ICP and TEMP values were obtained from ventricular catheters and systemic temperature sensors. Repeated NIRS-ICG measurements (2 injections within 30 minutes) were performed daily for determination of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time of ICG (mttICG). Delayed cerebral ischemia was defined as brain tissue oxygen tension <20 mmHg and/or lactate-pyruvate-ratio >35. Results: A total of 128 NIRS-ICG measurements were performed in 10 patients. The correlation coefficient between ICP and TEMP values obtained with the NIRS-ICP probe and values from routine monitoring was r=0.72 and r=0.96, respectively. The mean value was 30.3 ± 13.6 ml/100g/min for CBF, 3.3 ± 1.2 ml/100g for CBV, and 6.8 ± 1.6 sec for mttICG. The coefficient of variation from repeated NIRS-ICG measurements was 10.9% for CBF, 11.7% for CBV, and 3.8% for mttICG. The sensitivity for delayed cerebral ischemia detection was 85% and the specificity 83% using a CBFthreshold of 25 ml/100g/min. Conclusion: Multimodal monitoring using the NIRS-ICP probe is feasible with high reproducibility of measurement values and the ability to detect delayed cerebral ischemia. No safety concerns exist for the routine clinical use of the NIRS-ICP probe. monitoring as well as determination of cerebral hemodynamics using a near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution method (NIRS-ICP probe). Methods:The NIRS-ICP probe was applied after aneurysmal subarachnoid hemorrhage if multimodal monitoring was established due to poor neurological condition. ICP and TEMP values were obtained from ventricular catheters and systemic temperature sensors. Repeated NIRS-ICG measurements (2 injections within 30 minutes) were performed daily for determination of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time of ICG (mttICG). Delayed cerebral ischemia was defined as brain tissue oxygen tension <20 mmHg and/or lactate-pyruvate-ratio >35.Results: A total of 128 NIRS-ICG measurements were performed in 10 patients. The correlation coefficient between ICP and TEMP values obtained with the NIRS-ICP probe and values from routine monitoring was r=0.72 and r=0.96, respectively. The mean value was 30.3 ± 13.6 ml/100g/min for CBF, 3.3 ± 1.2 ml/100g for CBV, and 6.8 ± 1.6 sec for mttICG. The coefficient of variation from repeated NIRS-ICG measurements was 10.9% for CBF, 11.7% for CBV, and 3.8% for mttICG. The sensitivity for delayed cerebral ischemia detection was 85% and the specificity 83% using a CBFthreshold of 25 ml/100g/min. Conclusion:Multimodal monitoring using the NIRS-ICP...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

et al. 2016

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“…TD CBF monitoring may be beneficial in patients with TBI (7), SAH (8) and during neurosurgical procedures. CBF ≤ 15 ml/100 g/min is predictive of a secondary vasospasm following SAH (8). TD may also guide a triple H therapy in SAH (9).…”

Section: Thermal Diffusion (Td)mentioning

confidence: 99%

Multimodal neuromonitoring

Macas¹,

Bilskienė²,

Gembickij³

et al. 2012

AML

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The goal of the intensive care management of a neurosurgical patient is to preserve adequate cerebral perfusion, oxygenation and metabolism in order to prevent secondary neurological injury. In preventing secondary neurological insults interventions must be started early. For many years conventional methods of neuromonitoring have proved their efficacy. However, their sensitivity in detecting subtle metabolic derangements in the real time manner is low and the valuable time for the appropriate treatment is lost. In recent years, there are numerous study data suggesting that implying of advanced neuromonitoring techniques can improve outcomes. Moreover, it helps to guide goal-directed therapy. Although data on advanced neuromonitoring are preliminary and mostly observational, the number of modern neurosurgical centers applying it as a standard is high. With the increasing technical possibilities, the concept of multimodal neuromonitoring is of increasing popularity. Multimodal neuromonitoring allows continuous real time assessment of cerebral perfusion, oxygenation, metabolism and global function which makes it attractive and promising in clinical practice.

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“…En effet, le protocole de prise en charge de ces patients, dont le pronostic est grevé par un risque de 30 à 60 % (King, 1997) d'ischémie retardée par vasospasme (50 % des patients ayant souffert d'une ischémie retardée conserveront un handicap définitif), prévoit après traitement la réalisation de scanners de perfusion pour évaluer le retentissement d'aval dès le début des signes cliniques et adapter la prise en charge (Vajkoczy et al, 2003). Le pronostic vital et fonctionnel d'un malade après une rupture d'anévrysme est lié à la gravité initiale de l'hémorragie, mais aussi secondairement à la sévérité de ce vasospasme.…”

Section: Introductionunclassified

Irradiation des cristallins des patients par scanners de perfusion itératifs : dosimétrie et optimisation

Guersen¹,

Cassagnes²,

Mechin³

et al. 2014

Radioprotection

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Reçu le 26 août 2013 -Accepté le 5 février 2014Résumé -Le cristallin est un organe radiosensible. En avril 2011, la Commission Internationale de Protection Radiologique (CIPR) fixait à 500 mGy la nouvelle dose seuil d'apparition d'effets déterministes au cristallin. Les patients qui présentent un anévrysme intracérébral rompu bénéficient d'examens scanographiques de l'encéphale (CT) justifiés, pour le diagnostic et le suivi post traitement, réalisé le plus souvent par embolisation radioguidée. Ces examens itératifs exposent le cristallin aux rayons X. Cet article chiffre l'exposition des cristallins de 18 patients ayant bénéficié en 2011 d'examens scanographiques encéphaliques suite à une rupture d'anévrysme intracérébral, et propose un moyen de diminuer cette exposition. Dans notre étude, 44 % des patients étudiés ont reçu une dose supérieure à 500 mGy au niveau des yeux, générée par les examens scanographiques et en particulier les CT de perfusion, indispensables pour évaluer le risque d'ischémie retardée par vasospasme. Nous avons observé qu'en positionnant les patients en hyper flexion cervicale lors de la réalisation des scanners de perfusion, la dose aux cristallins pouvait être diminuée de près de 50 %.Abstract -Eye lens irradiation by CT perfusion: dosimetry and optimization. The lens of the eye is a radiosensitive organ. In April 2011, the International Commission on Radiological Protection (ICRP) set the new threshold dose of occurrence of deterministic lens effects to 500 mGy. Patients with a ruptured intracranial aneurysm are imaged by CT scans of the brain (CT), for diagnosis and post-treatment follow-up; embolization is the standard treatment. These iterative examinations expose the lens to X-rays. This paper evaluates the lens X-ray exposure of 18 patients who underwent encephalic CT scans after a ruptured intracranial aneurysm in 2011, and proposes a method to reduce this exposure. In our study, 44% of patients received eye doses greater than 500 mGy, generated by CT examinations, especially cerebral CT perfusion, necessary to assess the risk of delayed vasospasm/ischemia. By positioning the patient in neck hyperflexion for cerebral CT perfusion, the dose could be reduced by around 50%.

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Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage

Abstract: Thermal-diffusion flowmetry represents a promising method for the bedside monitoring of patients with SAH to detect symptomatic vasospasm. This is of major clinical interest for patients with high-grade SAH, who often cannot be assessed neurologically.

Cited by 191 publications

References 26 publications

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

Multimodal neuromonitoring

Irradiation des cristallins des patients par scanners de perfusion itératifs : dosimétrie et optimisation

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