gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Multimodal cerebral monitoring: regional cerebral blood flow, brain tissue oxygenation and microdialysis in aneurysmal subarachnoid hemorrhage

Mulimodales zerebrales Monitoring: Regionaler zerebraler Blutfluss, Hirngewebsoxygenierung und Mikrodialyse bei Patienten mit aneurysmatischer Subarachnoidalblutung

Meeting Abstract

  • corresponding author D. Haux - Neurochirurgische Universitätsklinik, Ruprecht-Karls-Universität Heidelberg
  • O. W. Sakowitz - Neurochirurgische Universitätsklinik, Ruprecht-Karls-Universität Heidelberg
  • K. Krajewski - Neurochirurgische Universitätsklinik, Ruprecht-Karls-Universität Heidelberg
  • A. W. Unterberg - Neurochirurgische Universitätsklinik, Ruprecht-Karls-Universität Heidelberg
  • K. Kiening - Neurochirurgische Universitätsklinik, Ruprecht-Karls-Universität Heidelberg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocDO.01.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 11. April 2007

© 2007 Haux et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: Due to the local circumscribed sampling volume, intracerebral monitoring techniques such as regional cerebral blood flow (rCBF), brain tissue partial pressure of oxygen (ptiO2), and microdialysis (MD) may be limited to detect cerebral vasospasm (VSP) alone in patients with aneurysmal subarachnoid hemorrhage (SAH). Administered simultaneously, these continuous online methods may facilitate detection of VSP in a Multimodal Cerebral Monitoring setup.

Methods: So far, seven patients (f:m 5:2, SAH °III-V WFNS, 3 aneurysms coiled, 4 clipped). All patients were monitored for ICP (separate burr hole/external drainage) and CBF (Qflow500, Hemedex), ptiO2 (Licox, Integra), and MD (CMA) through a frontal bolt kit. Episodes of hypoperfusion (rCBF≤18ml/min/100g) and hypoxia (ptiO2<10mmHg) had to last for at least 10 minutes to be counted. Pathological thresholds in MD were defined as glutamate>5µM, lactate>5mM and L/P-ratio>25.

Results: Overall MCM-time was 228±81.0 hours. Every patient revealed multiple episodes of cerebral hypoperfusion. 255 such episodes were recognized in all patients but only 11 episodes of cerebral hypoxia. In median (25-;75-quartile), 48.1% (24.6; 92.6%) of the monitored rCBF was below the ischemic threshold and 1.5% (0.6; 17.5%) of the ptiO2 data were hypoxic. In two patients, VSP developed during monitoring and resulted in infarction on control CT. These patients had simultaneous episodes of hypoperfusion and hypoxia for 526 and 1060 minutes and showed pathological MD values. One patient presented with severe VSP on initial angiography. In this patient, perfusion and microdialysis were pathological throughout the monitoring period. In three patients, no simultaneous episodes of hypoperfusion/hypoxia occurred, these patients were not affected by VSP.

Conclusions: The exclusive monitoring of rCBF or ptiO2 may be insufficient to detect relevant ischemia due to VSP alone. Short episodes of hypoperfusion do not necessarily seem to lead to definite tissue damage. However, simultaneous hypoperfusion and hypoxia for several minutes with according pathological metabolic patterns are indicative for developing infarction due to VSP. Thus, the Multimodal Cerebral Monitoring approach seems to be of great value to interpret online assessed data in SAH patients.