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Kommer M, Hawthorne C, Moss L, Piper I, O'Kane R, Czosnyka M, Enblad P, Hemphill JC, Spiegelberg A, Riddell JS, Shaw M. International e-Delphi survey to define best practice in the reporting of intracranial pressure monitoring recording data. BRAIN & SPINE 2024; 4:102860. [PMID: 39149423 PMCID: PMC11325271 DOI: 10.1016/j.bas.2024.102860] [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: 06/14/2023] [Revised: 04/25/2024] [Accepted: 07/03/2024] [Indexed: 08/17/2024]
Abstract
Introduction Intracranial pressure (ICP) monitoring is a very commonly performed neurosurgical procedure but there is a wide variation in how it is reported, hindering analysis of it. The current study sought to generate consensus on the reporting of ICP monitoring recording data. Research question "What should be included in an ICP monitoring report?" Material and methods The exercise was completed via a modified eDelphi survey. An expert panel discussion was held from which themes were identified and used to produce a code to annotate the transcript of the discussion. Statements were generated for a further two rounds of electronic questionnaires distributed via the REDcap platform. A Likert scale was used to grade agreement with each statement in the survey. A statement was accepted if more than 70% agreement was achieved between respondents. Data was collated using Microsoft Excel and analysed using R. Results 149 relevant statements were identified from the transcript and categorised into recording parameters, waveform characteristics or reporting. A total of 22 statements were generated for the first round of the survey which was answered by 39 respondents. Following the electronic round of surveys consensus was achieved for all but one statement regarding the acceptability of automating ICP reporting. This was put forward to a second round after which 79% agreement was reached. Discussion and conclusion The themes and statements from this eDelphi can be used as a framework to allow the standardisation of the reporting of intracranial pressure monitoring data.
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Affiliation(s)
- Maya Kommer
- NHS Greater Glasgow Clyde, UK
- University of Glasgow, UK
| | | | - Laura Moss
- NHS Greater Glasgow Clyde, UK
- University of Glasgow, UK
| | | | - Roddy O'Kane
- NHS Greater Glasgow Clyde, UK
- Royal Hospital for Children Glasgow, UK
| | - Marek Czosnyka
- Division of Neurosurgery, Cambridge University Hospitals, UK
| | - Per Enblad
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - J Claude Hemphill
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Andreas Spiegelberg
- The Interface Group, Institute of Physiology, University of Zurich, Switzerland
| | - John S Riddell
- University of Glasgow, UK
- Centre for Neuroscience, Psychology & Neuroscience Education Hub, School of Psychology and Neuroscience, University of Glasgow, UK
| | - Martin Shaw
- NHS Greater Glasgow Clyde, UK
- University of Glasgow, UK
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Motroni V, Cucciolini G, Beqiri E, Smith CA, Placek M, Chu KH, Czosnyka M, Smielewski P. Reliability and variability of pressure reactivity index (prx) during oscillatory pattern in arterial blood pressure and intracranial pressure in traumatic brain injured patients. BRAIN & SPINE 2024; 4:102850. [PMID: 39005582 PMCID: PMC11246011 DOI: 10.1016/j.bas.2024.102850] [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: 07/02/2023] [Revised: 05/06/2024] [Accepted: 06/09/2024] [Indexed: 07/16/2024]
Abstract
Introduction Pressure reactivity index (PRx) is used for continuous monitoring of cerebrovascular reactivity in traumatic brain injury (TBI). However, PRx has a noisy character. Oscillations in arterial blood pressure (ABP) introduced by cyclic positive end-expiratory pressure adjustment, can make PRx more reliable. However, if oscillations are introduced by the cycling process of an anti-decubitus-mattress the effect on PRx is confounding, as they affect directly also intracranial pressure (ICP). In our routine monitoring in TBI patients we noticed periods of highly regular, slow, spontaneous oscillations in ABP and ICP signals. Research question We set out to explore the nature of these oscillations and establish if PRx remains reliable during the oscillations. Materials and methods 10 TBI patients' recordings with oscillations in ICP and ABP were analysed. We computed PRx, PRx variability (hourly-average of standard-deviation, SD), phase-shift and coherence between ABP and ICP in the slow frequency range. Metrics were compared between oscillation and peri-oscillation periods. Results During oscillations (frequency 0.006 ± 0.002Hz), a significantly lower variability of PRx (SD 0.185vs0.242) and higher coherence ABP-ICP (0.618 ± 0.09 vs 0.534 ± 0.09) were observed. No external oscillations sources could be identified. 34 out of 48 events showed signs of 'active' transmission associated with negative PRx, indicating a potential positive impact on PRx reliability. Discussion and conclusions Spontaneous oscillations observed in ABP and ICP signals were found to enhance rather than confound PRx reliability. Further research is warranted to elucidate the nature of these oscillations and develop strategies to leverage them for enhancing PRx reliability in TBI monitoring.
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Affiliation(s)
- Virginia Motroni
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Giada Cucciolini
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Erta Beqiri
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK
| | - Claudia Ann Smith
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK
| | - Michael Placek
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK
| | - Ka Hing Chu
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK
| | - Marek Czosnyka
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK
| | - Peter Smielewski
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, UK
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Teo EJ, Petautschnig S, Hellerstedt J, Grace SA, Savage JS, Fafiani B, Smith PD, Jhamb A, Haydon T, Dixon B. Cerebrovascular Responses in a Patient with Lundberg B Waves Following Subarachnoid Haemorrhage Assessed with a Novel Non-Invasive Brain Pulse Monitor: A Case Report. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:73-87. [PMID: 38404631 PMCID: PMC10886819 DOI: 10.2147/mder.s452938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Subarachnoid haemorrhage (SAH) can trigger a range of poorly understood cerebrovascular responses that may play a role in delayed cerebral ischemia. The brain pulse monitor is a novel non-invasive device that detects a brain photoplethysmography signal that provides information on intracranial pressure (ICP), compliance, blood flow and tissue oxygen saturation. We monitored the cerebrovascular responses in a patient with Lundberg B waves following a SAH. The patient presented with a Fischer grade 4 SAH that required urgent left posterior communicating artery aneurysm coiling and ventricular drain insertion. On hospital day 4 oscillations or spikes on the invasive ICP were noted, consistent with Lundberg B waves. Brain pulse monitoring demonstrated concurrent pulse waveform features consistent with reduced brain compliance and raised ICP over both brain hemispheres. Oxygen levels also demonstrated slow oscillations correlated with the ICP spikes. Brief infrequent episodes of reduced and absent brain pulses were also noted over the right hemisphere. Our findings suggest that the brain pulse monitor holds promise for early detection of delayed cerebral ischemia and could offer insights into the vascular mechanisms at play.
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Affiliation(s)
- Elliot John Teo
- Cyban Pty Ltd, Melbourne, Victoria, Australia
- Department of Critical Care Medicine, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Sigrid Petautschnig
- Cyban Pty Ltd, Melbourne, Victoria, Australia
- Department of Critical Care Medicine, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | | | | | | | | | - Paul Daniel Smith
- Department of Neurosurgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
- University of Melbourne Medical School, Melbourne, VIC, Australia
| | - Ashu Jhamb
- Department of Medical Imaging, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Timothy Haydon
- Department of Critical Care Medicine, St Vincent’s Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, the University of Melbourne, Melbourne, VIC, Australia
| | - Barry Dixon
- Cyban Pty Ltd, Melbourne, Victoria, Australia
- Department of Medical Imaging, St Vincent’s Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, the University of Melbourne, Melbourne, VIC, Australia
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Schönenberg-Tu AL, Cysarz D, Petzold B, Blümel CB, Raak C, Fricke O, Edelhäuser F, Scharbrodt W. Pressure Time Dose as a Representation of Intracranial Pressure Burden and Its Dependency on Intracranial Pressure Waveform Morphology at Different Time Intervals. SENSORS (BASEL, SWITZERLAND) 2023; 23:8051. [PMID: 37836881 PMCID: PMC10574990 DOI: 10.3390/s23198051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
Intracranial pressure (ICP) burden or pressure time dose (PTD) is a valuable clinical indicator for pending intracranial hypertension, mostly based on threshold exceedance. Pulse frequency and waveform morphology (WFM) of the ICP signal contribute to PTD. The temporal resolution of the ICP signal has a great influence on PTD calculation but has not been systematically studied yet. Hence, the temporal resolution of the ICP signal on PTD calculation is investigated. We retrospectively analysed continuous 48 h ICP recordings with high temporal resolution obtained from 94 patients at the intensive care unit who underwent neurosurgery due to an intracranial haemorrhage and received an intracranial pressure probe (43 females, median age: 72 years, range: 23 to 88 years). The cumulative area under the curve above the threshold of 20 mmHg was compared for different temporal resolutions of the ICP signal (beat-to-beat, 1 s, 300 s, 1800 s, 3600 s). Events with prolonged ICP elevation were compared to those with few isolated threshold exceedances. PTD increased for lower temporal resolutions independent of WFM and frequency of threshold exceedance. PTDbeat-to-beat best reflected the impact of frequency of threshold exceedance and WFM. Events that could be distinguished in PTDbeat-to-beat became magnified more than 7-fold in PTD1s and more than 104 times in PTD1h, indicating an overestimation of PTD. PTD calculation should be standardised, and beat-by-beat PTD could serve as an easy-to-grasp indicator for the impact of frequency and WFM of ICP elevations on ICP burden.
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Affiliation(s)
- Anna-Li Schönenberg-Tu
- Chair of Integrative Neuro-Medicine, Gemeinschaftskrankenhaus Herdecke, 58313 Herdecke, Germany
| | - Dirk Cysarz
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
- Integrated Curriculum for Anthroposophic Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
| | - Benjamin Petzold
- Chair of Integrative Neuro-Medicine, Gemeinschaftskrankenhaus Herdecke, 58313 Herdecke, Germany
| | - Carl Benjamin Blümel
- Chair of Integrative Neuro-Medicine, Gemeinschaftskrankenhaus Herdecke, 58313 Herdecke, Germany
| | - Christa Raak
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
| | - Oliver Fricke
- Faculty of Health, Department of Human Medicine, Witten/Herdecke University, 58455 Witten, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Klinikum Stuttgart, 70174 Stuttgart, Germany
| | - Friedrich Edelhäuser
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
- Integrated Curriculum for Anthroposophic Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
| | - Wolfram Scharbrodt
- Chair of Integrative Neuro-Medicine, Gemeinschaftskrankenhaus Herdecke, 58313 Herdecke, Germany
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
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Cucciolini G, Motroni V, Czosnyka M. Intracranial pressure for clinicians: it is not just a number. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:31. [PMID: 37670387 PMCID: PMC10481563 DOI: 10.1186/s44158-023-00115-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Invasive intracranial pressure (ICP) monitoring is a standard practice in severe brain injury cases, where it allows to derive cerebral perfusion pressure (CPP); ICP-tracing can also provide additional information about intracranial dynamics, forecast episodes of intracranial hypertension and set targets for a tailored therapy to prevent secondary brain injury. Nevertheless, controversies about the advantages of an ICP clinical management are still debated. FINDINGS This article reviews recent research on ICP to improve the understanding of the topic and uncover the hidden information in this signal that may be useful in clinical practice. Parameters derived from time-domain as well as frequency domain analysis include compensatory reserve, autoregulation estimation, pulse waveform analysis, and behavior of ICP in time. The possibility to predict the outcome and apply a tailored therapy using a personalised perfusion pressure target is also described. CONCLUSIONS ICP is a crucial signal to monitor in severely brain injured patients; a bedside computer can empower standard monitoring giving new metrics that may aid in clinical management, establish a personalized therapy, and help to predict the outcome. Continuous collaboration between engineers and clinicians and application of new technologies to healthcare, is vital to improve the accuracy of current metrics and progress towards better care with individualized dynamic targets.
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Affiliation(s)
- Giada Cucciolini
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, Cambridge, UK.
| | - Virginia Motroni
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, Cambridge, UK
| | - Marek Czosnyka
- Department of Clinical Neurosciences, Division of Neurosurgery, Brain Physics Laboratory, University of Cambridge, Cambridge, UK
- Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
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Denchev K, Gomez J, Chen P, Rosenblatt K. Traumatic Brain Injury: Intraoperative Management and Intensive Care Unit Multimodality Monitoring. Anesthesiol Clin 2023; 41:39-78. [PMID: 36872007 DOI: 10.1016/j.anclin.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Traumatic brain injury is a devastating event associated with substantial morbidity. Pathophysiology involves the initial trauma, subsequent inflammatory response, and secondary insults, which worsen brain injury severity. Management entails cardiopulmonary stabilization and diagnostic imaging with targeted interventions, such as decompressive hemicraniectomy, intracranial monitors or drains, and pharmacological agents to reduce intracranial pressure. Anesthesia and intensive care requires control of multiple physiologic variables and evidence-based practices to reduce secondary brain injury. Advances in biomedical engineering have enhanced assessments of cerebral oxygenation, pressure, metabolism, blood flow, and autoregulation. Many centers employ multimodality neuromonitoring for targeted therapies with the hope to improve recovery.
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Affiliation(s)
- Krassimir Denchev
- Department of Anesthesiology, Wayne State University, 44555 Woodward Avenue, SJMO Medical Office Building, Suite 308, Pontiac, MI 48341, USA
| | - Jonathan Gomez
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA
| | - Pinxia Chen
- Department of Anesthesiology and Critical Care Medicine, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Kathryn Rosenblatt
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA; Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA.
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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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Newell DW, Nedergaard M, Aaslid R. Physiological Mechanisms and Significance of Intracranial B Waves. Front Neurol 2022; 13:872701. [PMID: 35651339 PMCID: PMC9149212 DOI: 10.3389/fneur.2022.872701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/20/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Recently published studies have described slow spontaneous cerebral blood flow (CBF) and cerebrospinal fluid (CSF) oscillations measured by magnetic resonance imaging (MRI) as potential drivers of brain glymphatic flow, with a similar frequency as intracranial B-waves. Aiming to establish the relationship between these waveforms, we performed additional analysis of frequency and waveform parameters, of our previously published transcranial Doppler (TCD) and intracranial pressure (ICP) recordings of intracranial B waves, to compare to published MRI frequency measurements of CBF and CSF slow oscillations. Patients and Methods We analyzed digital recordings of B waves in 29 patients with head injury, including middle cerebral artery (MCA) flow velocity (FV), ICP, end tidal CO2, and arterial blood pressure (ABP). A subset of these recordings demonstrated high B wave activity and was further analyzed for parameters including frequency, interaction, and waveform distribution curve features. These measures were compared to published similar measurements of spontaneous CBF and CSF fluctuations evaluated using MRI. Results In patients with at least 10% amplitude B wave activity, the MCA blood flow velocity oscillations comprising the B waves, had a maximum amplitude at 0.0245 Hz, and time derivative a maximum amplitude at 0.035 Hz. The frequency range of the B waves was between 0.6–2.3 cycles per min (0.011-0.038 Hz), which is in the same range as MRI measured CBF slow oscillations, reported in human volunteers. Waveform asymmetry in MCA velocity and ICP cycles during B waves, was also similar to published MRI measured CBF slow oscillations. Cross-correlation analysis showed equivalent time derivatives of FV vs. ICP in B waves, compared to MRI measured CBF slow oscillations vs. CSF flow fluctuations. Conclusions The TCD and ICP recordings of intracranial B waves show a similar frequency range as CBF and CSF flow oscillations measured using MRI, and share other unique morphological wave features. These findings strongly suggest a common physiological mechanism underlying the two classes of phenomena. The slow blood flow and volume oscillations causing intracranial B waves appear to be part of a cascade that may provide a significant driving force for compartmentalized CSF movement and facilitate glymphatic flow.
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Affiliation(s)
- David W Newell
- Department of Neurosurgery, Seattle Neuroscience Institute, Seattle, WA, United States
| | - Maiken Nedergaard
- Department of Basic and Translational Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Translational Neuromedicine, University of Rochester Medical School, Rochester, NY, United States
| | - Rune Aaslid
- Department of Neurosurgery, University of Bern, Bern, Switzerland
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Rasmussen SM, Nielsen T, Hager H, Schousboe LP. Spatial analysis of photoplethysmography in cutaneous squamous cell carcinoma. Sci Rep 2022; 12:7318. [PMID: 35513459 PMCID: PMC9072381 DOI: 10.1038/s41598-022-10924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/30/2022] [Indexed: 11/30/2022] Open
Abstract
The primary treatment of the common malignancy squamous cell carcinoma is surgical removal. In this process, sufficient tissue removal is balanced against unnecessary mutilation. We recently presented a remote photoplethysmography algorithm, which revealed significant differences between processed video recordings of cancer biopsy areas and surrounding tissue. The aim of this study was to investigate whether spatial analyses of photoplethysmography data correlate with post-excision pathological analyses and thus have potential to assist in tumour delineation. Based on high speed video recordings of 11 patients with squamous cell carcinoma, we examined different parameters derived from temporal remote photoplethysmography variations. Signal characteristics values in sites matching histological sections were compared with pathological measures. Values were ranked and statistically tested with a Kendall correlation analysis. A moderate, negative correlation was found between signal oscillations and the width and transversal area of squamous cell carcinoma in the frequencies below 1 Hz and specifically from 0.02 to 0.15 Hz. We have presented a correlation between frequency content and prevalence of cancer based on regular video recordings of squamous cell carcinoma. We believe this is supported by published findings on malignant melanoma. Our findings indicate that photoplethysmography can be used to distinguish SCC from healthy skin.
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Affiliation(s)
| | - Thomas Nielsen
- Department of Electrical and Computer Engineering, Aarhus University, 8000, Aarhus N, Denmark
| | - Henrik Hager
- Department of Clinical Pathology, Vejle Hospital, 7100, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark
| | - Lars Peter Schousboe
- Department of Otolaryngology, Southdanish University Hospital, 7100, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark
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Martinez-Tejada I, Riedel CS, Juhler M, Andresen M, Wilhjelm JE. k-Shape clustering for extracting macro-patterns in intracranial pressure signals. Fluids Barriers CNS 2022; 19:12. [PMID: 35123535 PMCID: PMC8817510 DOI: 10.1186/s12987-022-00311-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/21/2022] [Indexed: 11/27/2022] Open
Abstract
Background Intracranial pressure (ICP) monitoring is a core component of neurosurgical diagnostics. With the introduction of telemetric monitoring devices in the last years, ICP monitoring has become feasible in a broader clinical setting including monitoring during full mobilization and at home, where a greater diversity of ICP waveforms are present. The need for identification of these variations, the so-called macro-patterns lasting seconds to minutes—emerges as a potential tool for better understanding the physiological underpinnings of patient symptoms. Methods We introduce a new methodology that serves as a foundation for future automatic macro-pattern identification in the ICP signal to comprehensively understand the appearance and distribution of these macro-patterns in the ICP signal and their clinical significance. Specifically, we describe an algorithm based on k-Shape clustering to build a standard library of such macro-patterns. Results In total, seven macro-patterns were extracted from the ICP signals. This macro-pattern library may be used as a basis for the classification of new ICP variation distributions based on clinical disease entities. Conclusions We provide the starting point for future researchers to use a computational approach to characterize ICP recordings from a wide cohort of disorders.
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11
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Martinez-Tejada I, Czosnyka M, Czosnyka Z, Juhler M, Smielewski P. Causal relationship between slow waves of arterial, intracranial pressures and blood velocity in brain. Comput Biol Med 2021; 139:104970. [PMID: 34735948 DOI: 10.1016/j.compbiomed.2021.104970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Slow vasogenic waves in arterial blood pressure (ABP), intracranial pressure (ICP) and cerebral blood flow velocity (FV) carry information on multiple brain homeostatic control mechanisms. This work presents an approach to evaluate causal relation between oscillatory modes of these signals as an alternative to time or frequency domain Granger analysis. METHODS Forty-five patients with simultaneous recordings of ICP, ABP and FV during CSF infusion studies were examined retrospectively. Each time series was decomposed into ten intrinsic mode functions (IMFs) via Ensemble Empirical Mode Decomposition (EEMD) and, afterwards, Granger causality (GC) was computed. RESULTS Slow waves of ICP, ABP and FV were reconstructed from mode functions IMF6-9 of each time series, covering a frequency range between 0.013 and 0.155 Hz. Most significant connections were from FV to ICP, being stronger during elevation of mean ICP during infusion study. No G-causality was found between any of the IMFs during the baseline phase. CONCLUSION Nonlinearity and nonstationarity of the cerebral and systemic signals can be addressed using EEMD decomposition There is a causal influence of slow waves of FV on slow waves on ICP during the plateau phase of the infusion study for a frequency band between 0.095 and 0.155 Hz. This relationship is magnified during mild intracranial hypertension.
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Affiliation(s)
- Isabel Martinez-Tejada
- Rigshospitalet, Clinic of Neurosurgery, Blegdamsvej 9, Copenhagen, 2100, Denmark; Technical University of Denmark, Department of Health Technology, Orsteds Pl. 345C, Kongens Lyngby, 2800, Denmark.
| | - Marek Czosnyka
- University of Cambridge, Brain Physics Laboratory, Division of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Zofia Czosnyka
- University of Cambridge, Brain Physics Laboratory, Division of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Marianne Juhler
- Rigshospitalet, Clinic of Neurosurgery, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Peter Smielewski
- University of Cambridge, Brain Physics Laboratory, Division of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
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Pérez-Sánchez J, Carrillo de Gea JM, Rodríguez Barceló S, Toval Á, Fernández-Alemán JL, García-Berná JA, Popović M, Toval A. Intracranial pressure analysis software: A mapping study and proposal. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 209:106334. [PMID: 34450483 DOI: 10.1016/j.cmpb.2021.106334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
Introduction Intracranial pressure (ICP) monitoring and analysis are techniques that are, each year, applied to millions of patients with pathologies with million of patients annually. The detection of the so called A and B-waves, and the analysis of subtle changes in C-waves, which are present in ICP waveform, may indicate decreased intracranial compliance, and may improve the clinical outcome. Despite the advances in the field of computerized data analysis, the visual screening of ICP continues to be the means principally employed to detect these waves. To the best of our knowledge, no review study has addressed automated ICP analysis in sufficient detail and a need to research the state of the art of ICP analysis has, therefore, been identified. Methodology This paper presents a systematic mapping study to provide answers to 7 research questions: publication time, venue and source trends, medical tasks undertaken, research methods used, computational systems developed, validation methodology, tools and systems employed for evaluation and research problems identified. An ICP software prototype is presented and evaluated as a consequence of the results. Results A total of 23 papers, published between 1990 and 2020, were selected from 6 online databases. After analyzing these papers, the following information was obtained: diagnosis and monitoring medical tasks were addressed to the same extent, and the main research method used was evaluation research. Several computational systems were identified in the papers, the main one being image classification, while the main analysis objective was single pulse analysis. Correlation with expert analysis was the most frequent validation method, and few of the papers stated the use of a published dataset. Few authors referred to the tools used to build or evaluate the proposed solutions. The most frequent research problem was the need for new analysis methods. These results have inspired us to propose a software prototype with which provide an automated solution that integrates ICP analysis and monitoring techniques. Conclusions The papers in this study were selected and classified with regard to ICP automated analysis methods. Several research gaps were identified, which the authors of this study have employed as a based on which to recommend future work. Furthermore, this study has identified the need for an empirical comparison between methods, which will require the use and development of certain standard metrics. An in-depth analysis conducted by means of systematic literature review is also required. The software prototype evaluation provided positive results, showing that the prototype may be a reliable system for A-wave detection.
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Affiliation(s)
- Juanjo Pérez-Sánchez
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain.
| | - Juan M Carrillo de Gea
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain.
| | | | - Ángel Toval
- Department of Human Anatomy and Psychobiology, Faculty of Medicine, University of Murcia, Murcia, Spain; Institute of Biomedical Research of Murcia, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain.
| | - José L Fernández-Alemán
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain.
| | - José A García-Berná
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain.
| | - Miroljub Popović
- Department of Human Anatomy and Psychobiology, Faculty of Medicine, University of Murcia, Murcia, Spain; Institute of Biomedical Research of Murcia, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain.
| | - Ambrosio Toval
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain.
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Perioperative Dynamics of Intracranial B-waves of Blood Flow Velocity in the Basal Cerebral Arteries in Patients with Brain Arteriovenous Malformation. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021. [PMID: 33839820 DOI: 10.1007/978-3-030-59436-7_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Intracranial B-waves (8-30 mHz) of blood flow velocity (BFV) in the cerebral arteries are observed in various pathologies of the brain. Changes in B-waves of BFV in pathological arteriovenous shunting and "steal" syndrome remain poorly understood. The aim of this study was to evaluate the dynamics of the B-wave amplitude of BFV (BWA) in patients with an arteriovenous malformation (AVM) in the brain. In 38 such patients, cerebral autoregulation (CA) was assessed using a cuff test and transfer function analysis of the mean blood pressure (BP) and BFV in the basal cerebral arteries within the range of Mayer waves (80-120 mHz). BWA was calculated with spectral analysis. Reliable CA impairment was denoted on the AVM side as compared with the contralateral side prior to intervention. BWA was greater on the AVM side (4.5 ± 2.7 cm/s) than on the contralateral side (2.2 ± 1.4 cm/s, p < 0.05). After embolization, there was a reliable improvement (p < 0.05) in CA and a decrease in BWA on the AVM side (2.7 ± 1.8 cm/s). Thus, a considerable increase in BWA on the AVM side that is not induced by BP fluctuations may indicate additional compensation for blood flow under conditions of reduced perfusion pressure. This assumption is supported by a reduction in BWA after AVM embolization.
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Bar N, Sobel JA, Penzel T, Shamay Y, Behar JA. From sleep medicine to medicine during sleep-a clinical perspective. Physiol Meas 2021; 42. [PMID: 33794516 DOI: 10.1088/1361-6579/abf47c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/01/2021] [Indexed: 01/01/2023]
Abstract
Objective. In this perspective paper, we aim to highlight the potential of sleep as an auspicious time for diagnosis, management and therapy of non-sleep-specific pathologies.Approach. Sleep has a profound influence on the physiology of body systems and biological processes. Molecular studies have shown circadian-regulated shifts in protein expression patterns across human tissues, further emphasizing the unique functional, behavioral and pharmacokinetic landscape of sleep. Thus, many pathological processes are also expected to exhibit sleep-specific manifestations. Modern advances in biosensor technologies have enabled remote, non-invasive recording of a growing number of physiologic parameters and biomarkers promoting the detection and study of such processes.Main results. Here, we introduce key clinical studies in selected medical fields, which leveraged novel technologies and the advantageous period of sleep to diagnose, monitor and treat pathologies. Studies demonstrate that sleep is an ideal time frame for the collection of long and clean physiological time series data which can then be analyzed using data-driven algorithms such as deep learning.Significance.This new paradigm proposes opportunities to further harness modern technologies to explore human health and disease during sleep and to advance the development of novel clinical applications - from sleep medicine to medicine during sleep.
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Affiliation(s)
- Nitai Bar
- Israel Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Jonathan A Sobel
- Biomedical Engineering Faculty, Technion-Israel Institute of Technology, Haifa, Israel
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charite University Medicine Berlin, Chariteplatz 1, D-10117 Berlin, Germany.,Saratov State University, Saratov, Russia
| | - Yosi Shamay
- Biomedical Engineering Faculty, Technion-Israel Institute of Technology, Haifa, Israel
| | - Joachim A Behar
- Biomedical Engineering Faculty, Technion-Israel Institute of Technology, Haifa, Israel
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Attarpour A, Ward J, Chen JJ. Vascular origins of low-frequency oscillations in the cerebrospinal fluid signal in resting-state fMRI: Interpretation using photoplethysmography. Hum Brain Mapp 2021; 42:2606-2622. [PMID: 33638224 PMCID: PMC8090775 DOI: 10.1002/hbm.25392] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
In vivo mapping of cerebrovascular oscillations in the 0.05–0.15 Hz remains difficult. Oscillations in the cerebrospinal fluid (CSF) represent a possible avenue for noninvasively tracking these oscillations using resting‐state functional MRI (rs‐fMRI), and have been used to correct for vascular oscillations in rs‐fMRI functional connectivity. However, the relationship between low‐frequency CSF and vascular oscillations remains unclear. In this study, we investigate this relationship using fast simultaneous rs‐fMRI and photoplethysmogram (PPG), examining the 0.1 Hz PPG signal, heart‐rate variability (HRV), pulse‐intensity ratio (PIR), and the second derivative of the PPG (SDPPG). The main findings of this study are: (a) signals in different CSF regions are not equivalent in their associations with vascular and tissue rs‐fMRI signals; (b) the PPG signal is maximally coherent with the arterial and CSF signals at the cardiac frequency, but coherent with brain tissue at ~0.2 Hz; (c) PIR is maximally coherent with the CSF signal near 0.03 Hz; and (d) PPG‐related vascular oscillations only contribute to ~15% of the CSF (and arterial) signal in rs‐fMRI. These findings caution against averaging all CSF regions when extracting physiological nuisance regressors in rs‐fMRI applications, and indicate the drivers of the CSF signal are more than simply cardiac. Our study is an initial attempt at the refinement and standardization of how the CSF signal in rs‐fMRI can be used and interpreted. It also paves the way for using rs‐fMRI in the CSF as a potential tool for tracking cerebrovascular health through, for instance, the potential relationship between PIR and the CSF signal.
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Affiliation(s)
- Ahmadreza Attarpour
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - James Ward
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - J Jean Chen
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
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Long-term monitoring of intracranial pressure in freely-moving rats; impact of different physiological states. Fluids Barriers CNS 2020; 17:39. [PMID: 32517699 PMCID: PMC7285467 DOI: 10.1186/s12987-020-00199-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background Elevated intracranial pressure (ICP) is observed in association with a range of brain disorders. There is limited insight into the regulatory mechanisms of ICP under physiological conditions, and consequently also under pathological conditions. Thereby, to understand the mechanisms underlying ICP dynamics, precise, valid and long-term ICP recordings are of importance in the preclinical setting. Herein, we used a novel telemetric system for ICP recordings which allowed for long-term recordings in freely-moving rats. The aim was to investigate ICP dynamics under different physiological states and investigate how factors such as surgery/recovery, body position, light–dark, co-housing, weight and anesthesia may influence ICP and its waveforms. Methods A telemetric device was implanted epidurally in rats and signals were recorded continuously for up to 50 days (n = 14). Recording was divided into three experimental periods: a surgical recovery period (RP), a physiological period (PP) and an experimental period (EP). Histology was performed to study the morphology of implanted rats and non-implanted rats (n = 17). Results For the first time, we can demonstrate continuous ICP recordings in freely-moving and co-housed rats for up to 50 days with a high degree of stability. The mean ICP in the recording periods were; RP: 3.2 ± 0.6 mmHg, PP: 5.0 ± 0.6 mmHg and EP: 4.7 ± 0.6 mmHg. In the RP, the ICP was significantly lower compared to the PP (P = 0.0034). Significant light–dark difference in ICP with 21% increase in respiratory slow-wave amplitude was observed in the co-housed animals but not in single-housed animals. The ICP signal was raised during the dark period relative to the light (Δ0.3 ± 0.07 mmHg, P = 0.0043). Administration of anesthesia gave a short-term increase in ICP followed by a significant decrease in ICP. No signs of tissue damage or inflammation were found in the implanted brains. Conclusions ICP dynamics were influenced by several factors such as, use of anesthesia, light–dark difference and housing conditions. Our study demonstrates the importance of performing ICP physiological measurements in freely-moving animals. This has significant implications for moving the preclinical research field forward in order to properly study ICP physiology during disease development and to explore drug targets for alleviating increased ICP.
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Evensen KB, Eide PK. Measuring intracranial pressure by invasive, less invasive or non-invasive means: limitations and avenues for improvement. Fluids Barriers CNS 2020; 17:34. [PMID: 32375853 PMCID: PMC7201553 DOI: 10.1186/s12987-020-00195-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/19/2020] [Indexed: 12/20/2022] Open
Abstract
Sixty years have passed since neurosurgeon Nils Lundberg presented his thesis about intracranial pressure (ICP) monitoring, which represents a milestone for its clinical introduction. Monitoring of ICP has since become a clinical routine worldwide, and today represents a cornerstone in surveillance of patients with acute brain injury or disease, and a diagnostic of individuals with chronic neurological disease. There is, however, controversy regarding indications, clinical usefulness and the clinical role of the various ICP scores. In this paper, we critically review limitations and weaknesses with the current ICP measurement approaches for invasive, less invasive and non-invasive ICP monitoring. While risk related to the invasiveness of ICP monitoring is extensively covered in the literature, we highlight other limitations in current ICP measurement technologies, including limited ICP source signal quality control, shifts and drifts in zero pressure reference level, affecting mean ICP scores and mean ICP-derived indices. Control of the quality of the ICP source signal is particularly important for non-invasive and less invasive ICP measurements. We conclude that we need more focus on mitigation of the current limitations of today's ICP modalities if we are to improve the clinical utility of ICP monitoring.
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Affiliation(s)
- Karen Brastad Evensen
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O. Box 4950, Nydalen, 0424, Oslo, Norway
- Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O. Box 4950, Nydalen, 0424, Oslo, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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