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Low intracranial compliance increases the impact of intracranial volume insults to the traumatized brain: A microdialysis study in a traumatic brain injury rodent model
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery. (Brain-IT)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery. (Brain-IT)
(Brain-IT)
(Brain-IT)
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2006 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 59, no 2, 367-373 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The vulnerability of the brain is Considered to be increased after trauma. The present study was undertaken to determine whether intracranial volume insults in the posttraumatic period led to increased metabolic disturbances if intracranial compliance was decreased.

METHODS: A weight drop technique with a brain compression of 1.5 mm was used for injury. Intracranial compensatory volume was decreased 60 mu l by placing rubber film between the dura mater and the bone. Intracranial volume insults were induced using the Bolus injection technique. Microdialysis was used to measure interstitial lactate, pyruvate, hypoxanthine, and glycerol. Fifty-two-rats Were allocated to trauma and sham groups with 0 to 3 layers of rubber film with and without intracranial volume insults.

RESULTS: In the groups with reduced intracranial volume exposed to intracranial volume insults, the time course of metabolic markers showed higher increases and slower recovery rates than for the other groups. Reduced intracranial volume or intracranial volume insults alone did not cause any changes compared with controls.

CONCLUSION: These results support the hypothesis that decreased intracranial compliance increases the vulnerability of the brain for secondary volume insults even with intracranial pressure at low levels between the insults. This finding has important clinical implications in that it stresses the need to identify patients with low intracranial compliance so that their treatment can be optimized.

Place, publisher, year, edition, pages
2006. Vol. 59, no 2, 367-373 p.
Keyword [en]
intracranial compliance, microdialysis, rat, traumatic brain injury
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95052DOI: 10.1227/01.NEU.0000222648.61065.38ISI: 000239763800045PubMedID: 16883177OAI: oai:DiVA.org:uu-95052DiVA: diva2:169115
Available from: 2006-11-06 Created: 2006-11-06 Last updated: 2011-06-22Bibliographically approved
In thesis
1. Intracranial Compliance and Secondary Brain Damage. Experimental and Clinical Studies in Traumatic Head Injury
Open this publication in new window or tab >>Intracranial Compliance and Secondary Brain Damage. Experimental and Clinical Studies in Traumatic Head Injury
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Traumatic brain injury (TBI) renders the brain more vulnerable to secondary insults. The increased vulnerability can probably be explained by a combination of disturbances in hemodynamics, metabolism and craniospinal dynamics. Reduced ability to compensate for added intracranial volume, i.e. reduced intracranial compliance (IC), is one possible mechanism. The aim of this thesis was to study the role of IC on the effect of secondary insults after TBI.

A rat TBI model was developed where IC could be altered without causing pathological increases in intracranial pressure (ICP). Reduction of IC was made by placing rubber film between the dura mater and bilateral bone flaps. A reduction of IC in terms of reduced Pressure Volume Index was confirmed. Microdialysis (MD) of extracellular fluid was used to monitor neurochemical changes. Reduced IC after TBI proved to increase the vulnerability of the brain to secondary intracranial volume insults according to neurochemical microdialysis markers. Reduced IC or intracranial volume insults alone did not cause any metabolic changes as compared to controls. Moderate posttraumatic hypotension (50mmHg for 30 min) induced 2 hrs after TBI, did not aggravate posttraumatic extracellular neurochemical changes significantly, irrespective of the level of IC. Although controversial, a mild to moderate hypotensive insult after initial posttraumatic stabilization may not be as detrimental as earlier believed.

The Spiegelberg Compliance Monitor and MD were simultaneously used in 10 TBI patients to get an impression of the clinical value of IC monitoring and the relationship between IC, temperature and MD Lactate/Pyruvate ratio. IC and MD could be monitored simultaneously in TBI patients. Higher L/P ratios were seen when IC was low. Patients with induced coma treatment had significantly higher average L/P ratios, possibly due to their poorer neurological condition. An indication was also found that in TBI patients with high temperatures, L/P ratio rose as IC decreased, but in patients with low temperature there was no effect of IC on L/P ratio. These data suggest the importance of avoiding hyperthermia in TBI patients, especially in patients with low or decreased IC (monitored or anticipated).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 70 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 191
Keyword
Neurosciences, Traumatic brain injury, Intracranial compliance, Secondary insults, Microdialysis, Neurointensive care, Neurovetenskap
Identifiers
urn:nbn:se:uu:diva-7214 (URN)91-554-6698-2 (ISBN)
Public defence
2006-11-24, Grönvallsalen, ingång 70, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2006-11-06 Created: 2006-11-06Bibliographically approved

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