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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Experiences of metabolic monitoring in pediatric head injury

Erfahrungen im metabolischen Monitoring beim Schädel-Hirn-Trauma im Kindes- und Jugendalter

Meeting Abstract

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  • corresponding author Michael Janka - Klinik für Neurochirurgie, Klinikum Fulda, Fulda
  • B. M. Hoelper - Klinik für Neurochirurgie, Klinikum Fulda, Fulda
  • F. Soldner - Klinik für Neurochirurgie, Klinikum Fulda, Fulda
  • R. Behr - Klinik für Neurochirurgie, Klinikum Fulda, Fulda

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 07.73

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Janka et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Experience in metabolic monitoring of paediatric head-injured patients is limited. Since several pathophysiological changes such as blood flow, compliance and resistance might be more pronounced compared to adults, metabolic monitoring might be more sensitive to those mechanisms. We present ten cases of head-injured paediatric patients with different injury patterns that were monitored by multimodal metabolic parameters.


In ten severely head-injured paediatric patients (mean age 14,5 years) ICP (Rehau), ptiO2 (Licox) and interstitial metabolic substrates (4 patients) using microdialysis (CMA 600) were continuously monitored. All data were collected together with clinical parameters into a data base and further analysed.


In 4 patients monitoring was not pathological (ICP < 20mmHg, ptiO2 >10mmHg). In all other six patients, very different pathophysiological patterns were seen: ICA of a 14 year-old-boy had to be occluded by ballon after traumatic rupture. ptiO2 <10mmHg decreased afterwards in the affected vascular territory without ICP increase above 20mmHg; ventricular tapping leading to a slight lowering of ICP effectively increased ptiO2 >15mmHg. Effectiveness of decompression for treatment of traumatic brain swelling is represented by monitoring in a 9 year old boy, while in a 17-year-old male who herniated due to untractable brain swelling showed no “early signs” in monitoring prior to herniation. Another 14-year-old girl with intermittent short periods (<5min) of ICP between 40-50mmHg with simultaneously normal ptiO2 >20mmHg and without decompression showed an excellent outcome.


We observed very heterogeneous monitoring patterns in head injured paediatric patients. Even if metabolic monitoring does not replace measurement of ICP, it might allow a better estimation of underlying pathophysiological mechanisms such as brain swelling, intracranial bleeding or vessel occlusion. Furthermore, in individual cases such as vessel occlusion, bilateral monitoring should be considered.