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61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Correlation of pressure-, oxygen- and flow- related indices of cerebrovascular reactivity in a porcine model of intracerebral hemorrhage

Meeting Abstract

  • Edgar Santos - University Hospital Heidelberg, Department of Neurosurgery, Heidelberg, Germany
  • Berk Orakcioglu - University Hospital Heidelberg, Department of Neurosurgery, Heidelberg, Germany
  • Modar Kentar - University Hospital Heidelberg, Department of Neurosurgery, Heidelberg, Germany
  • Yoichi Uozumiv - University Hospital Heidelberg, Department of Neurosurgery, Heidelberg, Germany
  • Michael Schöll - Department of Medical Informatics, University of Heidelberg, Germany
  • Andreas Unterberg - University Hospital Heidelberg, Department of Neurosurgery, Heidelberg, Germany
  • Oliver W. Sakowitz - University Hospital Heidelberg, Department of Neurosurgery, Heidelberg, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1867

DOI: 10.3205/10dgnc338, URN: urn:nbn:de:0183-10dgnc3380

Veröffentlicht: 16. September 2010

© 2010 Santos et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Impaired cerebrovascular reactivity (CR) has been associated with adverse outcome in patients with intracerebral hemorrhage (ICH). Microdialysis is a method to assess important aspects of brain metabolism. Changes in metabolite concentrations have been associated with primary and secondary brain damage. The aim of this study was to determine a pressure- , and oxygen-, and a flow- related index of CR in a porcine model of ICH and to correlate each of these indices with cerebral metabolite concentrations.

Methods: Continuous advanced multimodal monitoring including microdialysis, cerebral blood flow and PbrO2 probes were placed 1cm in front of the coronal suture in the grey white matter junction. Following a period of 1 hour of monitoring, an autologous arterial ICH with defined volumes (2 to 3 ml) was induced using a catheter tubing system connected to the femoral artery. Based on the data collected, pressure-, oxygen-, and flow-related autoregulation indices (PRx, ORx and FRx) were simultaneously calculated and hourly correlated with microdialysis metabolites including Glucose, Lactate, Pyruvate and Glutamate.

Results: All animals (n=17) were monitored on average 12 continuous hours. FRx highly correlated with ORx (0.96, P=<0.001) but values of both FRx and ORx >0.2 did not correlate with any microdialysis metabolite. PRx >0.2 highly correlated (0.65, P<0.001) with Lactate/Pyruvate ratio, PRx >0.3 correlated (0.67, P=0.01) with Glutamate. Individual monitoring demonstrated critical hypoxic episodes where PRx were high (>0.4). Simultaneous increases of Lactate and Glutamate, and decrease in Glucose were observed. These reversed after augmenting cerebral perfusion pressure and oxygenation. Nevertheless, there were occasional episodes where microdialysis revealed evidence of hypoxia that was not associated with PRx >0.2.

Conclusions: We found evidence for impaired cerebral vasomotor activity in a porcine model of ICH. The findings suggest that at least PRx abnormalities could be associated with microdialysis alterations during hypoxic events.