gms | German Medical Science

59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Spreading Depolarizations are associated with regional perfusion changes in patients with acute brain injury

„Spreading Depolarizations“ bei akut-hirnverletzten Patienten sind mit Änderungen der regionalen Perfusion verbunden

Meeting Abstract

  • corresponding author O.W. Sakowitz - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • K. L. Krajewski - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • D. Haux - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • B. Orakcioglu - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • K. L. Kiening - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • A. W. Unterberg - Neurochirurgische Klinik, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocDI.08.01

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Veröffentlicht: 30. Mai 2008

© 2008 Sakowitz et al.
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Objective: The recording of cortical spreading depression via perifocal electrocorticography is a novel addition to neurointensive multimodal monitoring after SAH, TBI and infarction. Despite 60 years of research, little is still known about the causes and effects of such spreading depolarizations (SD) on neuronal integrity and outcome. The aim of this project was to examine the relationship between SD and regional cerebral blood flow (CBF).

Methods: A total of 24 patients were enrolled (18 SAH, 3 TBI, 3 infarction; 13 female/11 male, mean age 52±11). Ipsilateral to the insult local cerebral perfusion probes (Bowman Perfusion Monitor; TD-CBF) were placed in parenchymatous tissue and in relation to a centrifugally placed 6-channel subdural strip electrode. Occurrence of SD and transient ischemic events (i.e. CBF <18ml/100g/min) were analyzed for a correlation.

Results: A total of 397 spreading depressions were observed in 13/24 patients (range: 0-94; mean 17.3±23.8/patient). Of these, 23.8% were associated with an accompanying pathological CBF value. Within 60 minutes prior to SD 25% of CBF values, and within 120 minutes immediately after SD 18.1% were pathological. A frequency distribution of the percentage of pathological CBF values shows a statistically significant increase at the time of SD followed by a compensatory reduction (for -60 min before SD: r=0.806, p-value=0.0206; for +60 min after SD: r=-0.904, p-value=0.003).

Conclusions: There is a strong correlation between the onset of spreading depressions and a decrease in CBF. This supports the idea that in a fraction of observed cases regional ischemia precedes SD, which is in turn followed by perfusion augmentation. Yet, an early impact of SD on CBF can not be ruled out, and is focus of ongoing studies.