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Lalou AD, Czosnyka ZH, Czosnyka M. Observational study of intracranial pressure instability in patients with pseudotumour cerebri syndrome. BRAIN & SPINE 2024; 4:102758. [PMID: 38510634 PMCID: PMC10951771 DOI: 10.1016/j.bas.2024.102758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
Introduction A fixed CSF pressure (CSFp) of 25 cmH2O (18 mmHg) has been utilised to date to define and classify pseudotumour cerebri syndrome (PTCS). Furthermore, ICP monitoring, and CSF infusion tests have not been frequently performed in this group of patients. Research question We aimed to report typical, unusual and unstable patterns of ICP in patients with PTCS. Material and methods We reviewed the recordings of CSF infusion tests and overnight ICP monitoring of patients with suspected or confirmed IIH between January 2003-December 2020.We excluded all patients with a shunt in situ and selected recordings that represented unstable patterns of ICP changes in PTCS. Results 463 CSF infusion tests and 26 ICP monitorings of PTCS patients had been performed in this timeframe. We divided results of observed pattern into two group: those with known venous sinus measurements (Group A) and those without (Group B). Observed recordings formed a total of 5 and 4 different patterns respectively, based on the behaviour of ICP and slow waves at rest, overnight, and during infusion as well as in relationship to the clinical presentation of each patient. Discussion and conclusion Accurate monitoring of ICP in PTCS is quintessential. Full understanding of each element of its pathophysiology and their interaction would be essential and include quantification of the CSF pressure not only as a number, but also with consideration of its dynamic contents. Cerebral venous pressure measurements and/or monitoring may be useful. Consideration of the presence or absence of papilloedema in the context of disturbed CSF dynamics could reveal further diagnostic and therapeutic insights.
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Affiliation(s)
- Afroditi D. Lalou
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge & Cambridge University Hospital NHS Foundation Trust, United Kingdom
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Radiation Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Zofia H. Czosnyka
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge & Cambridge University Hospital NHS Foundation Trust, United Kingdom
| | - Marek Czosnyka
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge & Cambridge University Hospital NHS Foundation Trust, United Kingdom
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Müller SJ, Henkes E, Gounis MJ, Felber S, Ganslandt O, Henkes H. Non-Invasive Intracranial Pressure Monitoring. J Clin Med 2023; 12:jcm12062209. [PMID: 36983213 PMCID: PMC10051320 DOI: 10.3390/jcm12062209] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
(1) Background: Intracranial pressure (ICP) monitoring plays a key role in the treatment of patients in intensive care units, as well as during long-term surgeries and interventions. The gold standard is invasive measurement and monitoring via ventricular drainage or a parenchymal probe. In recent decades, numerous methods for non-invasive measurement have been evaluated but none have become established in routine clinical practice. The aim of this study was to reflect on the current state of research and shed light on relevant techniques for future clinical application. (2) Methods: We performed a PubMed search for “non-invasive AND ICP AND (measurement OR monitoring)” and identified 306 results. On the basis of these search results, we conducted an in-depth source analysis to identify additional methods. Studies were analyzed for design, patient type (e.g., infants, adults, and shunt patients), statistical evaluation (correlation, accuracy, and reliability), number of included measurements, and statistical assessment of accuracy and reliability. (3) Results: MRI-ICP and two-depth Doppler showed the most potential (and were the most complex methods). Tympanic membrane temperature, diffuse correlation spectroscopy, natural resonance frequency, and retinal vein approaches were also promising. (4) Conclusions: To date, no convincing evidence supports the use of a particular method for non-invasive intracranial pressure measurement. However, many new approaches are under development.
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Affiliation(s)
- Sebastian Johannes Müller
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Correspondence: ; Tel.: +49-(0)711-278-34501
| | - Elina Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Matthew J. Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, MA 01655, USA
| | - Stephan Felber
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Stiftungsklinikum Mittelrhein, D-56068 Koblenz, Germany
| | - Oliver Ganslandt
- Neurochirurgische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, D-47057 Duisburg, Germany
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Maruccia F, Tagliabue S, Fischer JB, Kacprzak M, Pérez-Hoyos S, Rosas K, Álvarez ID, Sahuquillo J, Durduran T, Poca MA. Transcranial optical monitoring for detecting intracranial pressure alterations in children with benign external hydrocephalus: a proof-of-concept study. NEUROPHOTONICS 2022; 9:045005. [PMID: 36405998 PMCID: PMC9670160 DOI: 10.1117/1.nph.9.4.045005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
SIGNIFICANCE Benign external hydrocephalus (BEH) is considered a self-limiting pathology with a good prognosis. However, some children present a pathological intracranial pressure (ICP) characterized by quantitative and qualitative alterations (the so-called B-waves) that can lead to neurological sequelae. AIM Our purpose was to evaluate whether there were cerebral hemodynamic changes associated with ICP B-waves that could be evaluated with noninvasive neuromonitoring. APPROACH We recruited eleven patients (median age 16 months, range 7 to 55 months) with BEH and an unfavorable evolution requiring ICP monitoring. Bedside, nocturnal monitoring using near-infrared time-resolved and diffuse correlation spectroscopies synchronized to the clinical monitoring was performed. RESULTS By focusing on the timing of different ICP patterns that were identified manually by clinicians, we detected significant tissue oxygen saturation ( StO 2 ) changes ( p = 0.002 ) and blood flow index (BFI) variability ( p = 0.005 ) between regular and high-amplitude B-wave patterns. A blinded analysis looking for analogs of ICP patterns in BFI time traces achieved 90% sensitivity in identifying B-waves and 76% specificity in detecting the regular patterns. CONCLUSIONS We revealed the presence of StO 2 and BFI variations-detectable with optical techniques-during ICP B-waves in BEH children. Finally, the feasibility of detecting ICP B-waves in hemodynamic time traces obtained noninvasively was shown.
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Affiliation(s)
- Federica Maruccia
- Vall d’Hebron Barcelona Hospital Campus, Vall d’Hebron Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
- ICFO-Insitut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Susanna Tagliabue
- ICFO-Insitut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Jonas B. Fischer
- ICFO-Insitut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- HemoPhotonics S.L., Barcelona, Spain
| | - Michał Kacprzak
- ICFO-Insitut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
| | - Santi Pérez-Hoyos
- Vall d’Hebron Research Institute, Statistics and Bioinformatics Unit, Barcelona, Spain
| | - Katiuska Rosas
- Vall d’Hebron Barcelona Hospital Campus, Vall d’Hebron Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
- Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Department of Neurosurgery and Pediatric Neurosurgery Unit, Barcelona, Spain
| | - Ignacio Delgado Álvarez
- Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Department of Pediatric Neuroradiology, Barcelona, Spain
| | - Juan Sahuquillo
- Vall d’Hebron Barcelona Hospital Campus, Vall d’Hebron Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
- Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Department of Neurosurgery and Pediatric Neurosurgery Unit, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Turgut Durduran
- ICFO-Insitut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Maria A. Poca
- Vall d’Hebron Barcelona Hospital Campus, Vall d’Hebron Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
- Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Department of Neurosurgery and Pediatric Neurosurgery Unit, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
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Ayaz H, Baker WB, Blaney G, Boas DA, Bortfeld H, Brady K, Brake J, Brigadoi S, Buckley EM, Carp SA, Cooper RJ, Cowdrick KR, Culver JP, Dan I, Dehghani H, Devor A, Durduran T, Eggebrecht AT, Emberson LL, Fang Q, Fantini S, Franceschini MA, Fischer JB, Gervain J, Hirsch J, Hong KS, Horstmeyer R, Kainerstorfer JM, Ko TS, Licht DJ, Liebert A, Luke R, Lynch JM, Mesquida J, Mesquita RC, Naseer N, Novi SL, Orihuela-Espina F, O’Sullivan TD, Peterka DS, Pifferi A, Pollonini L, Sassaroli A, Sato JR, Scholkmann F, Spinelli L, Srinivasan VJ, St. Lawrence K, Tachtsidis I, Tong Y, Torricelli A, Urner T, Wabnitz H, Wolf M, Wolf U, Xu S, Yang C, Yodh AG, Yücel MA, Zhou W. Optical imaging and spectroscopy for the study of the human brain: status report. NEUROPHOTONICS 2022; 9:S24001. [PMID: 36052058 PMCID: PMC9424749 DOI: 10.1117/1.nph.9.s2.s24001] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This report is the second part of a comprehensive two-part series aimed at reviewing an extensive and diverse toolkit of novel methods to explore brain health and function. While the first report focused on neurophotonic tools mostly applicable to animal studies, here, we highlight optical spectroscopy and imaging methods relevant to noninvasive human brain studies. We outline current state-of-the-art technologies and software advances, explore the most recent impact of these technologies on neuroscience and clinical applications, identify the areas where innovation is needed, and provide an outlook for the future directions.
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Affiliation(s)
- Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science, and Health Systems, Philadelphia, Pennsylvania, United States
- Drexel University, College of Arts and Sciences, Department of Psychological and Brain Sciences, Philadelphia, Pennsylvania, United States
| | - Wesley B. Baker
- Children’s Hospital of Philadelphia, Division of Neurology, Philadelphia, Pennsylvania, United States
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Giles Blaney
- Tufts University, Department of Biomedical Engineering, Medford, Massachusetts, United States
| | - David A. Boas
- Boston University Neurophotonics Center, Boston, Massachusetts, United States
- Boston University, College of Engineering, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Heather Bortfeld
- University of California, Merced, Departments of Psychological Sciences and Cognitive and Information Sciences, Merced, California, United States
| | - Kenneth Brady
- Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Department of Anesthesiology, Chicago, Illinois, United States
| | - Joshua Brake
- Harvey Mudd College, Department of Engineering, Claremont, California, United States
| | - Sabrina Brigadoi
- University of Padua, Department of Developmental and Social Psychology, Padua, Italy
| | - Erin M. Buckley
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
| | - Stefan A. Carp
- Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Robert J. Cooper
- University College London, Department of Medical Physics and Bioengineering, DOT-HUB, London, United Kingdom
| | - Kyle R. Cowdrick
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Joseph P. Culver
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
| | - Ippeita Dan
- Chuo University, Faculty of Science and Engineering, Tokyo, Japan
| | - Hamid Dehghani
- University of Birmingham, School of Computer Science, Birmingham, United Kingdom
| | - Anna Devor
- Boston University, College of Engineering, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Turgut Durduran
- ICFO – The Institute of Photonic Sciences, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
| | - Adam T. Eggebrecht
- Washington University in St. Louis, Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
| | - Lauren L. Emberson
- University of British Columbia, Department of Psychology, Vancouver, British Columbia, Canada
| | - Qianqian Fang
- Northeastern University, Department of Bioengineering, Boston, Massachusetts, United States
| | - Sergio Fantini
- Tufts University, Department of Biomedical Engineering, Medford, Massachusetts, United States
| | - Maria Angela Franceschini
- Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Jonas B. Fischer
- ICFO – The Institute of Photonic Sciences, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Judit Gervain
- University of Padua, Department of Developmental and Social Psychology, Padua, Italy
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, Paris, France
| | - Joy Hirsch
- Yale School of Medicine, Department of Psychiatry, Neuroscience, and Comparative Medicine, New Haven, Connecticut, United States
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Keum-Shik Hong
- Pusan National University, School of Mechanical Engineering, Busan, Republic of Korea
- Qingdao University, School of Automation, Institute for Future, Qingdao, China
| | - Roarke Horstmeyer
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
- Duke University, Department of Electrical and Computer Engineering, Durham, North Carolina, United States
- Duke University, Department of Physics, Durham, North Carolina, United States
| | - Jana M. Kainerstorfer
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
- Carnegie Mellon University, Neuroscience Institute, Pittsburgh, Pennsylvania, United States
| | - Tiffany S. Ko
- Children’s Hospital of Philadelphia, Division of Cardiothoracic Anesthesiology, Philadelphia, Pennsylvania, United States
| | - Daniel J. Licht
- Children’s Hospital of Philadelphia, Division of Neurology, Philadelphia, Pennsylvania, United States
| | - Adam Liebert
- Polish Academy of Sciences, Nalecz Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
| | - Robert Luke
- Macquarie University, Department of Linguistics, Sydney, New South Wales, Australia
- Macquarie University Hearing, Australia Hearing Hub, Sydney, New South Wales, Australia
| | - Jennifer M. Lynch
- Children’s Hospital of Philadelphia, Division of Cardiothoracic Anesthesiology, Philadelphia, Pennsylvania, United States
| | - Jaume Mesquida
- Parc Taulí Hospital Universitari, Critical Care Department, Sabadell, Spain
| | - Rickson C. Mesquita
- University of Campinas, Institute of Physics, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
| | - Noman Naseer
- Air University, Department of Mechatronics and Biomedical Engineering, Islamabad, Pakistan
| | - Sergio L. Novi
- University of Campinas, Institute of Physics, Campinas, São Paulo, Brazil
- Western University, Department of Physiology and Pharmacology, London, Ontario, Canada
| | | | - Thomas D. O’Sullivan
- University of Notre Dame, Department of Electrical Engineering, Notre Dame, Indiana, United States
| | - Darcy S. Peterka
- Columbia University, Zuckerman Mind Brain Behaviour Institute, New York, United States
| | | | - Luca Pollonini
- University of Houston, Department of Engineering Technology, Houston, Texas, United States
| | - Angelo Sassaroli
- Tufts University, Department of Biomedical Engineering, Medford, Massachusetts, United States
| | - João Ricardo Sato
- Federal University of ABC, Center of Mathematics, Computing and Cognition, São Bernardo do Campo, São Paulo, Brazil
| | - Felix Scholkmann
- University of Bern, Institute of Complementary and Integrative Medicine, Bern, Switzerland
- University of Zurich, University Hospital Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zürich, Switzerland
| | - Lorenzo Spinelli
- National Research Council (CNR), IFN – Institute for Photonics and Nanotechnologies, Milan, Italy
| | - Vivek J. Srinivasan
- University of California Davis, Department of Biomedical Engineering, Davis, California, United States
- NYU Langone Health, Department of Ophthalmology, New York, New York, United States
- NYU Langone Health, Department of Radiology, New York, New York, United States
| | - Keith St. Lawrence
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Department of Medical Biophysics, London, Ontario, Canada
| | - Ilias Tachtsidis
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Yunjie Tong
- Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana, United States
| | - Alessandro Torricelli
- Politecnico di Milano, Dipartimento di Fisica, Milan, Italy
- National Research Council (CNR), IFN – Institute for Photonics and Nanotechnologies, Milan, Italy
| | - Tara Urner
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Heidrun Wabnitz
- Physikalisch-Technische Bundesanstalt (PTB), Berlin, Germany
| | - Martin Wolf
- University of Zurich, University Hospital Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zürich, Switzerland
| | - Ursula Wolf
- University of Bern, Institute of Complementary and Integrative Medicine, Bern, Switzerland
| | - Shiqi Xu
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Changhuei Yang
- California Institute of Technology, Department of Electrical Engineering, Pasadena, California, United States
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Meryem A. Yücel
- Boston University Neurophotonics Center, Boston, Massachusetts, United States
- Boston University, College of Engineering, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Wenjun Zhou
- University of California Davis, Department of Biomedical Engineering, Davis, California, United States
- China Jiliang University, College of Optical and Electronic Technology, Hangzhou, Zhejiang, China
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Zeiler FA, Aries M, Czosnyka M, Smieleweski P. Cerebral Autoregulation Monitoring in Traumatic Brain Injury: An Overview of Recent Advances in Personalized Medicine. J Neurotrauma 2022; 39:1477-1494. [PMID: 35793108 DOI: 10.1089/neu.2022.0217] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Impaired cerebral autoregulation (CA) in moderate/severe traumatic brain injury (TBI) has been identified as a strong associate with poor long-term outcomes, with recent data highlighting its dominance over cerebral physiologic dysfunction seen in the acute phase post injury. With advances in bedside continuous cerebral physiologic signal processing, continuously derived metrics of CA capacity have been described over the past two decades, leading to improvements in cerebral physiologic insult detection and development of novel personalized approaches to TBI care in the intensive care unit (ICU). This narrative review focuses on highlighting the concept of continuous CA monitoring and consequences of impairment in moderate/severe TBI. Further, we provide a comprehensive description and overview of the main personalized cerebral physiologic targets, based on CA monitoring, that are emerging as strong associates with patient outcomes. CA-based personalized targets, such as optimal cerebral perfusion pressure (CPPopt), lower/upper limit of regulation (LLR/ULR), and individualized intra-cranial pressure (iICP) are positioned to change the way we care for TBI patients in the ICU, moving away from the "one treatment fits all" paradigm of current guideline-based therapeutic approaches, towards a true personalized medicine approach tailored to the individual patient. Future perspectives regarding research needs in this field are also discussed.
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Affiliation(s)
- Frederick Adam Zeiler
- Health Sciences Centre, Section of Neurosurgery, GB-1 820 Sherbrook Street, Winnipeg, Manitoba, Canada, R3A1R9;
| | - Marcel Aries
- University of Maastricht Medical Center, Department of Intensive Care, Maastricht, Netherlands;
| | - Marek Czosnyka
- university of cambridge, neurosurgery, Canbridge Biomedical Campus, box 167, cambridge, United Kingdom of Great Britain and Northern Ireland, cb237ar;
| | - Peter Smieleweski
- Cambridge University, Neurosurgery, Cambridge, United Kingdom of Great Britain and Northern Ireland;
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Neuromonitoring in Severe Traumatic Brain Injury: A Bibliometric Analysis. Neurocrit Care 2022; 36:1044-1052. [PMID: 35075580 DOI: 10.1007/s12028-021-01428-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
Traumatic brain injury (TBI) is the leading cause of mortality and disability among trauma-related injuries. Neuromonitoring plays an essential role in the management and prognosis of patients with severe TBI. Our bibliometric study aimed to identify the knowledge base, define the research front, and outline the social networks on neuromonitoring in severe TBI. We conducted an electronic search for articles related to neuromonitoring in severe TBI in Scopus. A descriptive analysis retrieved evidence on the most productive authors and countries, the most cited articles, the most frequently publishing journals, and the most common author's keywords. Through a three-step network extraction process, we performed a collaboration analysis among universities and countries, a cocitation analysis, and a word cooccurrence analysis. A total of 1884 records formed the basis of our bibliometric study. We recorded an increasing scientific interest in the use of neuromonitoring in severe TBI. Czosnyka, Hutchinson, Menon, Smielewski, and Stocchetti were the most productive authors. The most cited document was a review study by Maas et al. There was an extensive collaboration among universities. The most common keywords were "intracranial pressure," with an increasing interest in magnetic resonance imaging and cerebral perfusion pressure monitoring. Neuromonitoring constitutes an area of active research. The present findings indicate that intracranial pressure monitoring plays a pivotal role in the management of severe TBI. Scientific interest shifts to magnetic resonance imaging and individualized patient care on the basis of optimal cerebral perfusion pressure.
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Lalou AD, Czosnyka M, Placek MM, Smielewski P, Nabbanja E, Czosnyka Z. CSF Dynamics for Shunt Prognostication and Revision in Normal Pressure Hydrocephalus. J Clin Med 2021; 10:jcm10081711. [PMID: 33921142 PMCID: PMC8071572 DOI: 10.3390/jcm10081711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite the quantitative information derived from testing of the CSF circulation, there is still no consensus on what the best approach could be in defining criteria for shunting and predicting response to CSF diversion in normal pressure hydrocephalus (NPH). OBJECTIVE We aimed to review the lessons learned from assessment of CSF dynamics in our center and summarize our findings to date. We have focused on reporting the objective perspective of CSF dynamics testing, without further inferences to individual patient management. DISCUSSION No single parameter from the CSF infusion study has so far been able to serve as an unquestionable outcome predictor. Resistance to CSF outflow (Rout) is an important biological marker of CSF circulation. It should not, however, be used as a single predictor for improvement after shunting. Testing of CSF dynamics provides information on hydrodynamic properties of the cerebrospinal compartment: the system which is being modified by a shunt. Our experience of nearly 30 years of studying CSF dynamics in patients requiring shunting and/or shunt revision, combined with all the recent progress made in producing evidence on the clinical utility of CSF dynamics, has led to reconsidering the relationship between CSF circulation testing and clinical improvement. CONCLUSIONS Despite many open questions and limitations, testing of CSF dynamics provides unique perspectives for the clinician. We have found value in understanding shunt function and potentially shunt response through shunt testing in vivo. In the absence of infusion tests, further methods that provide a clear description of the pre and post-shunting CSF circulation, and potentially cerebral blood flow, should be developed and adapted to the bed-space.
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Affiliation(s)
- Afroditi Despina Lalou
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK; (M.C.); (M.M.P.); (P.S.); (E.N.); (Z.C.)
- Correspondence: ; Tel.: +44-774-3567-585
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK; (M.C.); (M.M.P.); (P.S.); (E.N.); (Z.C.)
- Institute of Electronic Systems, Faculty of Electronics and Information Sciences, Warsaw University of Technology, 00-661 Warsaw, Poland
| | - Michal M. Placek
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK; (M.C.); (M.M.P.); (P.S.); (E.N.); (Z.C.)
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK; (M.C.); (M.M.P.); (P.S.); (E.N.); (Z.C.)
| | - Eva Nabbanja
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK; (M.C.); (M.M.P.); (P.S.); (E.N.); (Z.C.)
| | - Zofia Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK; (M.C.); (M.M.P.); (P.S.); (E.N.); (Z.C.)
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Ruesch A, Schmitt S, Yang J, Smith MA, Kainerstorfer JM. Fluctuations in intracranial pressure can be estimated non-invasively using near-infrared spectroscopy in non-human primates. J Cereb Blood Flow Metab 2020; 40:2304-2314. [PMID: 31775565 PMCID: PMC7585930 DOI: 10.1177/0271678x19891359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Intracranial pressure (ICP) is typically measured invasively through a sensor placed inside the brain or a needle inserted into the spinal canal, limiting the patient population on which this assessment can be performed. Currently, non-invasive methods are limited due to lack of sensitivity and thus only apply to extreme cases of increased ICP, instead of use in general clinical practice. We demonstrate a novel application for near-infrared spectroscopy (NIRS) to accurately estimate ICP changes over time. Using a non-human primate (Rhesus Macaque) model, we collected optical data while we induced ICP oscillations at multiple ICP levels obtained by manipulating the height of a fluid column connected via a catheter to the lateral ventricle. Hemodynamic responses to ICP changes were measured at the occipital pole and compared to changes detected by a conventional intraparenchymal ICP probe. We demonstrate that hemoglobin concentrations are highly correlated with induced ICP oscillations and that this response is frequency dependent. We translated the NIRS data into non-invasive ICP measurements via a fitted non-parametric transfer function, demonstrating a match in both magnitude and time alignment with an invasively measured reference. Our results demonstrate that NIRS has the potential for non-invasive ICP monitoring.
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Affiliation(s)
- Alexander Ruesch
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Samantha Schmitt
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.,Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason Yang
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Matthew A Smith
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.,Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA.,Carnegie Mellon Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Jana M Kainerstorfer
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.,Carnegie Mellon Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
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9
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Continuous Near-infrared Spectroscopy Monitoring in Adult Traumatic Brain Injury: A Systematic Review. J Neurosurg Anesthesiol 2020; 32:288-299. [DOI: 10.1097/ana.0000000000000620] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Canac N, Jalaleddini K, Thorpe SG, Thibeault CM, Hamilton RB. Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring. Fluids Barriers CNS 2020; 17:40. [PMID: 32576216 PMCID: PMC7310456 DOI: 10.1186/s12987-020-00201-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/11/2020] [Indexed: 12/30/2022] Open
Abstract
Measurement of intracranial pressure (ICP) is crucial in the management of many neurological conditions. However, due to the invasiveness, high cost, and required expertise of available ICP monitoring techniques, many patients who could benefit from ICP monitoring do not receive it. As a result, there has been a substantial effort to explore and develop novel noninvasive ICP monitoring techniques to improve the overall clinical care of patients who may be suffering from ICP disorders. This review attempts to summarize the general pathophysiology of ICP, discuss the importance and current state of ICP monitoring, and describe the many methods that have been proposed for noninvasive ICP monitoring. These noninvasive methods can be broken down into four major categories: fluid dynamic, otic, ophthalmic, and electrophysiologic. Each category is discussed in detail along with its associated techniques and their advantages, disadvantages, and reported accuracy. A particular emphasis in this review will be dedicated to methods based on the use of transcranial Doppler ultrasound. At present, it appears that the available noninvasive methods are either not sufficiently accurate, reliable, or robust enough for widespread clinical adoption or require additional independent validation. However, several methods appear promising and through additional study and clinical validation, could eventually make their way into clinical practice.
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11
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Ruesch A, Yang J, Schmitt S, Acharya D, Smith MA, Kainerstorfer JM. Estimating intracranial pressure using pulsatile cerebral blood flow measured with diffuse correlation spectroscopy. BIOMEDICAL OPTICS EXPRESS 2020; 11:1462-1476. [PMID: 32206422 PMCID: PMC7075623 DOI: 10.1364/boe.386612] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 05/08/2023]
Abstract
Measuring intracranial pressure (ICP) is necessary for the treatment of severe head injury but measurement systems are highly invasive and introduce risk of infection and complications. We developed a non-invasive alternative for quantifying ICP using measurements of cerebral blood flow (CBF) by diffuse correlation spectroscopy. The recorded cardiac pulsation waveform in CBF undergoes morphological changes in response to ICP changes. We used the pulse shape to train a randomized regression forest to estimate the underlying ICP and demonstrate in five non-human primates that DCS-based estimation can explain over 90% of the variance in invasively measured ICP.
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Affiliation(s)
- Alexander Ruesch
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Jason Yang
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Samantha Schmitt
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
- Neuroscience Institute, Carnegie Mellon University, 4400 Fifth Avenue, Pittsburgh, PA 15213, USA
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Deepshikha Acharya
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Matthew A. Smith
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
- Neuroscience Institute, Carnegie Mellon University, 4400 Fifth Avenue, Pittsburgh, PA 15213, USA
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Jana M. Kainerstorfer
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
- Neuroscience Institute, Carnegie Mellon University, 4400 Fifth Avenue, Pittsburgh, PA 15213, USA
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12
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Martinez-Tejada I, Arum A, Wilhjelm JE, Juhler M, Andresen M. B waves: a systematic review of terminology, characteristics, and analysis methods. Fluids Barriers CNS 2019; 16:33. [PMID: 31610775 PMCID: PMC6792201 DOI: 10.1186/s12987-019-0153-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background Although B waves were introduced as a concept in the analysis of intracranial pressure (ICP) recordings nearly 60 years ago, there is still a lack consensus on precise definitions, terminology, amplitude, frequency or origin. Several competing terms exist, addressing either their probable physiological origin or their physical characteristics. To better understand B wave characteristics and ease their detection, a literature review was carried out. Methods A systematic review protocol including search strategy and eligibility criteria was prepared in advance. A literature search was carried out using PubMed/MEDLINE, with the following search terms: B waves + review filter, slow waves + review filter, ICP B waves, slow ICP waves, slow vasogenic waves, Lundberg B waves, MOCAIP. Results In total, 19 different terms were found, B waves being the most common. These terminologies appear to be interchangeable and seem to be used indiscriminately, with some papers using more than five different terms. Definitions and etiologies are still unclear, which makes systematic and standardized detection difficult. Conclusions Two future lines of action are available for automating macro-pattern identification in ICP signals: achieving strict agreement on morphological characteristics of “traditional” B waveforms, or starting a new with a fresh computerized approach for recognition of new clinically relevant patterns.
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Affiliation(s)
- Isabel Martinez-Tejada
- Clinic of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. .,Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark.
| | - Alexander Arum
- Clinic of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens E Wilhjelm
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Marianne Juhler
- Clinic of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Andresen
- Clinic of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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13
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Narayan V, Mohammed N, Savardekar AR, Patra DP, Notarianni C, Nanda A. Noninvasive Intracranial Pressure Monitoring for Severe Traumatic Brain Injury in Children: A Concise Update on Current Methods. World Neurosurg 2018. [PMID: 29524721 DOI: 10.1016/j.wneu.2018.02.159] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality worldwide and intracranial pressure (ICP) monitoring plays a crucial role in its management. Based on existing literature, we review the current practicing noninvasive ICP monitoring devices and their accuracy in predicting increased ICP in pediatric TBI. METHODS A thorough literature search was conducted on PubMed, Medline, and the Cochrane database, articles were selected systematically and reviewed completely, and relevant data were summarized and discussed. RESULTS A total of 27 articles pertaining to pediatric TBI were included and reviewed. We found various modalities of noninvasive ICP monitoring devices used over the last few years. The noninvasive modalities so far attempted in pediatric TBI and so reviewed here are transcranial Doppler, optic nerve sheath diameter, otoacoustic emission, near-infrared spectroscopy, contrast-enhanced ultrasonography, and quantitative pupillometry. CONCLUSIONS Invasive monitoring methods are the current gold standard for monitoring ICP; however, complications caused by their invasive nature are of concern. Of all the noninvasive methods based on the literature, we found transcranial Doppler and optic nerve sheath diameter assessment to be the best tools to monitor ICP in pediatric TBI. The promising results and developments of noninvasive ICP monitoring modalities with its ideal features of high sensitivity, diagnostic accuracy, and simple acquisition technique may make it the future of neurointensive monitoring in pediatric TBI.
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Affiliation(s)
- Vinayak Narayan
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Nasser Mohammed
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Amey R Savardekar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Devi Prasad Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Christina Notarianni
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
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14
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Harary M, Dolmans RGF, Gormley WB. Intracranial Pressure Monitoring-Review and Avenues for Development. SENSORS (BASEL, SWITZERLAND) 2018; 18:E465. [PMID: 29401746 PMCID: PMC5855101 DOI: 10.3390/s18020465] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/25/2018] [Accepted: 02/01/2018] [Indexed: 12/27/2022]
Abstract
Intracranial pressure (ICP) monitoring is a staple of neurocritical care. The most commonly used current methods of monitoring in the acute setting include fluid-based systems, implantable transducers and Doppler ultrasonography. It is well established that management of elevated ICP is critical for clinical outcomes. However, numerous studies show that current methods of ICP monitoring cannot reliably define the limit of the brain's intrinsic compensatory capacity to manage increases in pressure, which would allow for proactive ICP management. Current work in the field hopes to address this gap by harnessing live-streaming ICP pressure-wave data and a multimodal integration with other physiologic measures. Additionally, there is continued development of non-invasive ICP monitoring methods for use in specific clinical scenarios.
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Affiliation(s)
- Maya Harary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Rianne G F Dolmans
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Department of Neurosurgery, University Medical Center, 3584 CS Utrecht, The Netherlands.
| | - William B Gormley
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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15
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Zhang X, Medow JE, Iskandar BJ, Wang F, Shokoueinejad M, Koueik J, Webster JG. Invasive and noninvasive means of measuring intracranial pressure: a review. Physiol Meas 2017; 38:R143-R182. [PMID: 28489610 DOI: 10.1088/1361-6579/aa7256] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Measurement of intracranial pressure (ICP) can be invaluable in the management of critically ill patients. Cerebrospinal fluid is produced by the choroid plexus in the brain ventricles (a set of communicating chambers), after which it circulates through the different ventricles and exits into the subarachnoid space around the brain, where it is reabsorbed into the venous system. If the fluid does not drain out of the brain or get reabsorbed, the ICP increases, which may lead to brain damage or death. ICP elevation accompanied by dilatation of the cerebral ventricles is termed hydrocephalus, whereas ICP elevation accompanied by normal or small ventricles is termed idiopathic intracranial hypertension. OBJECTIVE We performed a comprehensive literature review on how to measure ICP invasively and noninvasively. APPROACH This review discusses the advantages and disadvantages of current invasive and noninvasive approaches. MAIN RESULTS Invasive methods remain the most accurate at measuring ICP, but they are prone to a variety of complications including infection, hemorrhage and neurological deficits. Ventricular catheters remain the gold standard but also carry the highest risk of complications, including difficult or incorrect placement. Direct telemetric intraparenchymal ICP monitoring devices are a good alternative. Noninvasive methods for measuring and evaluating ICP have been developed and classified in five broad categories, but have not been reliable enough to use on a routine basis. These methods include the fluid dynamic, ophthalmic, otic, and electrophysiologic methods, as well as magnetic resonance imaging, transcranial Doppler ultrasonography (TCD), cerebral blood flow velocity, near-infrared spectroscopy, transcranial time-of-flight, spontaneous venous pulsations, venous ophthalmodynamometry, optical coherence tomography of retina, optic nerve sheath diameter (ONSD) assessment, pupillometry constriction, sensing tympanic membrane displacement, analyzing otoacoustic emissions/acoustic measure, transcranial acoustic signals, visual-evoked potentials, electroencephalography, skull vibrations, brain tissue resonance and the jugular vein. SIGNIFICANCE This review provides a current perspective of invasive and noninvasive ICP measurements, along with a sense of their relative strengths, drawbacks and areas for further improvement. At present, none of the noninvasive methods demonstrates sufficient accuracy and ease of use while allowing continuous monitoring in routine clinical use. However, they provide a realizable ICP measurement in specific patients especially when invasive monitoring is contraindicated or unavailable. Among all noninvasive ICP measurement methods, ONSD and TCD are attractive and may be useful in selected settings though they cannot be used as invasive ICP measurement substitutes. For a sufficiently accurate and universal continuous ICP monitoring method/device, future research and developments are needed to integrate further refinements of the existing methods, combine telemetric sensors and/or technologies, and validate large numbers of clinical studies on relevant patient populations.
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Affiliation(s)
- Xuan Zhang
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, United States of America
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16
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Weigl W, Milej D, Janusek D, Wojtkiewicz S, Sawosz P, Kacprzak M, Gerega A, Maniewski R, Liebert A. Application of optical methods in the monitoring of traumatic brain injury: A review. J Cereb Blood Flow Metab 2016; 36:1825-1843. [PMID: 27604312 PMCID: PMC5094301 DOI: 10.1177/0271678x16667953] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/28/2016] [Accepted: 07/18/2016] [Indexed: 01/19/2023]
Abstract
We present an overview of the wide range of potential applications of optical methods for monitoring traumatic brain injury. The MEDLINE database was electronically searched with the following search terms: "traumatic brain injury," "head injury," or "head trauma," and "optical methods," "NIRS," "near-infrared spectroscopy," "cerebral oxygenation," or "cerebral oximetry." Original reports concerning human subjects published from January 1980 to June 2015 in English were analyzed. Fifty-four studies met our inclusion criteria. Optical methods have been tested for detection of intracranial lesions, monitoring brain oxygenation, assessment of brain perfusion, and evaluation of cerebral autoregulation or intracellular metabolic processes in the brain. Some studies have also examined the applicability of optical methods during the recovery phase of traumatic brain injury . The limitations of currently available optical methods and promising directions of future development are described in this review. Considering the outstanding technical challenges, the limited number of patients studied, and the mixed results and opinions gathered from other reviews on this subject, we believe that optical methods must remain primarily research tools for the present. More studies are needed to gain confidence in the use of these techniques for neuromonitoring of traumatic brain injury patients.
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Affiliation(s)
- Wojciech Weigl
- Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Akademiska Hospital, Uppsala, Sweden
| | - Daniel Milej
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Dariusz Janusek
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Stanisław Wojtkiewicz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Sawosz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Michał Kacprzak
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Gerega
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Roman Maniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Adam Liebert
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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17
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Abstract
Assessing intracranial pressure (ICP) remains a cornerstone in neurosurgical care. Invasive techniques for monitoring ICP remain the gold standard. The need for a reliable, safe and reproducible technique to non-invasively assess ICP in the context of early screening and in the neurocritical care environment is obvious. Numerous techniques have been described with several novel advances. While none of the currently available techniques appear independently accurate enough to quantify raised ICP, there is some promising work being undertaken.
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18
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Advances in Intracranial Pressure Monitoring and Its Significance in Managing Traumatic Brain Injury. Int J Mol Sci 2015; 16:28979-97. [PMID: 26690122 PMCID: PMC4691093 DOI: 10.3390/ijms161226146] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 12/11/2022] Open
Abstract
Intracranial pressure (ICP) measurements are essential in evaluation and treatment of neurological disorders such as subarachnoid and intracerebral hemorrhage, ischemic stroke, hydrocephalus, meningitis/encephalitis, and traumatic brain injury (TBI). The techniques of ICP monitoring have evolved from invasive to non-invasive-with both limitations and advantages. Some limitations of the invasive methods include short-term monitoring, risk of infection, restricted mobility of the subject, etc. The invasiveness of a method limits the frequency of ICP evaluation in neurological conditions like hydrocephalus, thus hampering the long-term care of patients with compromised ICP. Thus, there has been substantial interest in developing noninvasive techniques for assessment of ICP. Several approaches were reported, although none seem to provide a complete solution due to inaccuracy. ICP measurements are fundamental for immediate care of TBI patients in the acute stages of severe TBI injury. In severe TBI, elevated ICP is associated with mortality or poor clinical outcome. ICP monitoring in conjunction with other neurological monitoring can aid in understanding the pathophysiology of brain damage. This review article presents: (a) the significance of ICP monitoring; (b) ICP monitoring methods (invasive and non-invasive); and (c) the role of ICP monitoring in the management of brain damage, especially TBI.
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19
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Abstract
Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care.
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20
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Davies DJ, Su Z, Clancy MT, Lucas SJE, Dehghani H, Logan A, Belli A. Near-Infrared Spectroscopy in the Monitoring of Adult Traumatic Brain Injury: A Review. J Neurotrauma 2015; 32:933-41. [PMID: 25603012 DOI: 10.1089/neu.2014.3748] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cerebral near-infrared spectroscopy (NIRS) has long represented an exciting prospect for the noninvasive monitoring of cerebral tissue oxygenation and perfusion in the context of traumatic brain injury (TBI), although uncertainty still exists regarding the reliability of this technology specifically within this field. We have undertaken a review of the existing literature relating to the application of NIRS within TBI. We discuss current "state-of-the-art" NIRS monitoring, provide a brief background of the technology, and discuss the evidence regarding the ability of NIRS to substitute for established invasive monitoring in TBI.
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Affiliation(s)
- David J Davies
- 1 Department of Neurosurgery Clinical Research, Queen Elizabeth Hospital , Edgbaston, Birmingham, United Kingdom
| | - Zhangjie Su
- 1 Department of Neurosurgery Clinical Research, Queen Elizabeth Hospital , Edgbaston, Birmingham, United Kingdom
| | - Michael T Clancy
- 2 School of Computational Science Medical Imaging Group, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Samuel J E Lucas
- 3 Department of Exercise Physiology, School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Hamid Dehghani
- 4 Department of Medical Imaging, School of Computer Science, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Ann Logan
- 5 Department of Molecular Neuroscience, School of Clinical and Experimental Medicine, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Antonio Belli
- 6 Department of Surgical Neurology, National Institute for Health Research, Queen Elizabeth Hospital , Edgbaston, Birmingham, United Kingdom
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21
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Abstract
Measurement of intracranial pressure (ICP) is critical for the evaluation and management of many neurological and neurosurgical conditions. The invasiveness of ICP measurement limits the frequency with which ICP can be evaluated, hampering the clinical care of patients with ICP disorders. Thus, there has been substantial interest in developing noninvasive methods for the assessment of ICP. Numerous approaches have been applied to the problem, although none seems to represent a complete solution. The goal of this review is to familiarize the reader with the currently available methods to noninvasively evaluate ICP.
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Affiliation(s)
- Beau B Bruce
- Departments of Ophthalmology and Neurology, Emory University, Atlanta, Georgia
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22
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Kawoos U, Meng X, Huang SM, Rosen A, McCarron RM, Chavko M. Telemetric intracranial pressure monitoring in blast-induced traumatic brain injury. IEEE Trans Biomed Eng 2014; 61:841-7. [PMID: 24557686 DOI: 10.1109/tbme.2013.2291239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The long-term monitoring of intracranial pressure (ICP) is important for the management of acute and chronic neuropathological conditions which include head injury, traumatic brain injury, hydrocephalus, etc. In this study, we developed an implantable device for measuring ICP over long periods of time in an animal model of blast-induced brain injury. The performance of the device was first evaluated in vitro and subsequently utilized to measure ICP in rats exposed to blast overpressures. The effects of blast-induced brain injury on ICP were measured for six days. A significant difference was observed between the injured group and the nonexposed control group. ICP in injured animals showed a biphasic transient increase; an immediate increase within the first 1-3 h and a more gradual elevation occurring two days after the blast. The ability to monitor changes of ICP continuously over long periods after brain injury and during the course of treatment may improve the prognosis after injury and can also serve as a tool in determining the therapeutic effectiveness of new drugs.
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Brain monitoring: do we need a hole? An update on invasive and noninvasive brain monitoring modalities. ScientificWorldJournal 2014; 2014:795762. [PMID: 24672373 PMCID: PMC3930194 DOI: 10.1155/2014/795762] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/07/2013] [Indexed: 01/19/2023] Open
Abstract
The ability to measure reliably the changes in the physical and biochemical environment after a brain injury is of great value in the prevention, treatment, and understanding of the secondary injuries. Three categories of multimodal brain monitoring exist: direct signals which are monitored invasively; variables which may be monitored noninvasively; and variables describing brain pathophysiology which are not monitored directly but are calculated at the bedside by dedicated computer software. Intracranial pressure (ICP) monitoring, either as stand-alone value or study of a dynamic trend, has become an important diagnostic tool in the diagnosis and management of multiple neurological conditions. Attempts have been made to measure ICP non-invasively, but this is not a clinical reality yet. There is contrasting evidence that monitoring of ICP is associated with better outcome, and further RCTs based on management protocol are warranted. Computer bedside calculation of “secondary parameters” has shown to be potentially helpful, particularly in helping to optimize “CPP-guided therapy.” In this paper we describe the most popular invasive and non invasive monitoring modalities, with great attention to their clinical interpretation based on the current published evidence.
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