Intraventricular Cooling During CSF Infusion Studies
We implemented ventricular infusion studies on 33 patients suspected of idiopathic normal pressure hydrocephalus (iNPH), benign intracranial hypertension (BIH) or occlusive hydrocephalus (HOC) in order to confirm shunt indications. The initial scope was t
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Abstract We implemented ventricular infusion studies on 33 patients suspected of idiopathic normal pressure hydrocephalus (iNPH), benign intracranial hypertension (BIH) or occlusive hydrocephalus (HOC) in order to confirm shunt indications. The initial scope was to study O2 supply during infusion tests to exclude further violation of already vulnerable brains during ICP elevation. Intraventricular infusion was performed via ventricle catheters with the ICP tip sensor, while brain tissue oxygenation was measured with intraparenchymal Raumedic PTO probes. In 15 out of 23 (65%; 8 NPH, 2BIH, 5 HOC), pO2 increased constantly (average 140%), while brain temperature decreased (range: 0.2–4.5°C) during the infusion studies. In another six patients, O2 values remained largely stable during the infusion studies (4NPH, 1BIH, 1HOC). Cerebral deoxygenation during infusion tests occurred only in two patients (1NPH, 1HOC). Overall cerebral oxygenation and temperature inversely correlated well with some temporary delay regarding oxygenation state as a consequence of cerebral temperature. Probably, this effect is a consequence of reduced cerebral metabolism caused by local cooling. We hypothesise that such cooling is mediated via the large basal arteries and suggest that such a pathophysiology, ICP-controlled local cooling, might offer a new option for brain protection (e.g. in an ICP crisis). Keywords ICP • ICP treatment • Cerebral metabolism • CSF hydrodynamics • Cerebral oxygen partial pressure • Cerebral temperature
Introduction We performed ventricular infusion studies in patients with suspected idiopathic normal pressure hydrocephalus (iNPH), benign intracranial hypertension (BIH) or occlusive
M. Schmitt (), R. Eymann, S. Antes, and M. Kiefer Department of Neurosurgery, Saarland University, Medical School, Kirrberger Straße, Building 90.5, 66421 Homburg, Germany e-mail: [email protected]
hydrocephalus (HOC) to confirm shunt indications. To exclude cerebral O2 desaturation during such ICP elevation, we monitored brain tissue oxygenation.
Materials and Methods Ventricular infusion studies were implemented in 33 patients, who were divided into three groups: Idiopathic normal pressure hydrocephalus (iNPH, 16 patients: 11 female, 5 male), benign intracranial hypertension (BIH, 5 patients: 4 female, 1 male) and occlusive hydrocephalus (HOC, 12 patients: 4 female, 8 male). Average age of the iNPH, BIH, and HOC groups were 72.87 ± 7.9, 32.4 ± 13.1 and 54.75 ± 19.9 years respectively. Evans index served as ventricular size estimation. To reduce the bias as much as possible, only patients in whom we performed ventricular infusion studies and who obtained general anaesthesia (at the patient’s request) were included in the study. As a general in-house policy of our anaesthesiologists concerning patients with increased intracranial pressure (ICP), FiO2 was kept constant at 100%. Further on, to ensure sufficient cerebral perfusion pressure (>60 mmHg), mean arterial blood pressure (MAP) was kept between 85 and 95 mmHg.
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