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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Continuous assessment of cerebral autoregulation during spreading depolarization in a porcine model of intracerebral hemorrhage

Meeting Abstract

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  • Renán Sánchez-Porras - Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
  • Martin Seule - Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany; Neurointensive Care Unit, Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
  • Patrick Schiebel - Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
  • Humberto Silos - Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
  • Edgar Santos - Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
  • Berk Orakcioglu - Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
  • Andreas W. Unterberg - Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
  • Oliver W. Sakowitz - Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 010

doi: 10.3205/14dgnc405, urn:nbn:de:0183-14dgnc4051

Published: May 13, 2014

© 2014 Sánchez-Porras et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Spreading depolarization (SD) is implicated in the pathophysiology of intracerebral hemorrhage (ICH). Cerebral autoregulation and pressure-reactivity can be impaired following SD and ICH. The aim of this study was to analyze the cerebral autoregulatory changes after SD assessed throughout cerebrovascular pressure reactivity and oxygen pressure reactivity indices in a porcine model of autologous ICH.

Method: Nine male swine were craniotomized and continuously monitored for physiological parameters including mean arterial blood pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), partial pressure of brain tissue oxygen (PbrO2) and electrocorticography (ECoG) for SD detection. An autologous arterial ICH was induced. Cerebrovascular pressure reactivity index (PRx), long-frequency pressure reactivity index (L-PRx), PbrO2 pressure reactivity index (ORx) and a high-frequency ORx (H-ORx), were simultaneously calculated and compared with the time points after SD onset.

Results: A total of 22 SD events were elicited in 66.66% of animals. SDs were elicited at intervals of 47.10 ± 57.17 min. They presented with an amplitude of 4.4 ± 1.5 mV and propagation velocity of 1.87 ± 1.02 mm/min for a total duration of 11.85 ± 3.22 min. After SD the indices exhibited fluctuations of preserved, impaired and preserved autoregulation for approximately 30 min, which were visible in 40.90% of the SD events for PRx and L-PRx. Such changes were observable in 86.36% of the SD events for ORx and H-ORx. Increases in ICP (15.43%), PbrO2 (10.90%) and CPP (4.01%), as well as a reduction in MAP (0.77%) were found after SD and were associated with autoregulation impairment.

Conclusions: Cerebrovascular pressure reactivity and PbrO2 pressure reactivity indices can indicate autoregulatory impairment after SD in a porcine model of autologous ICH. In particular, autoregulatory responses registered at high-frequencies are promising parameters to demonstrate autoregulatory disruption.

Note: Renán Sánchez-Porras and Martin Seule contributed equally to this work.