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Roldan M, Abay TY, Uff C, Kyriacou PA. A pilot clinical study to estimate intracranial pressure utilising cerebral photoplethysmograms in traumatic brain injury patients. Acta Neurochir (Wien) 2024; 166:109. [PMID: 38409283 PMCID: PMC10896864 DOI: 10.1007/s00701-024-06002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/03/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE In this research, a non-invasive intracranial pressure (nICP) optical sensor was developed and evaluated in a clinical pilot study. The technology relied on infrared light to probe brain tissue, using photodetectors to capture backscattered light modulated by vascular pulsations within the brain's vascular tissue. The underlying hypothesis was that changes in extramural arterial pressure could affect the morphology of recorded optical signals (photoplethysmograms, or PPGs), and analysing these signals with a custom algorithm could enable the non-invasive calculation of intracranial pressure (nICP). METHODS This pilot study was the first to evaluate the nICP probe alongside invasive ICP monitoring as a gold standard. nICP monitoring occurred in 40 patients undergoing invasive ICP monitoring, with data randomly split for machine learning. Quality PPG signals were extracted and analysed for time-based features. The study employed Bland-Altman analysis and ROC curve calculations to assess nICP accuracy compared to invasive ICP data. RESULTS Successful acquisition of cerebral PPG signals from traumatic brain injury (TBI) patients allowed for the development of a bagging tree model to estimate nICP non-invasively. The nICP estimation exhibited 95% limits of agreement of 3.8 mmHg with minimal bias and a correlation of 0.8254 with invasive ICP monitoring. ROC curve analysis showed strong diagnostic capability with 80% sensitivity and 89% specificity. CONCLUSION The clinical evaluation of this innovative optical nICP sensor revealed its ability to estimate ICP non-invasively with acceptable and clinically useful accuracy. This breakthrough opens the door to further technological refinement and larger-scale clinical studies in the future. TRIAL REGISTRATION NCT05632302, 11th November 2022, retrospectively registered.
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Affiliation(s)
- Maria Roldan
- Research Centre for Biomedical Engineering, School of Science & Technology, University of London, London, EC1V 0HB, UK.
| | - Tomas Ysehak Abay
- Research Centre for Biomedical Engineering, School of Science & Technology, University of London, London, EC1V 0HB, UK
| | - Christopher Uff
- Barts Health NHS Trust: Royal London Hospital, E1 1BB, London, UK
| | - Panayiotis A Kyriacou
- Research Centre for Biomedical Engineering, School of Science & Technology, University of London, London, EC1V 0HB, UK
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2
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Qin Y, Liu Y, Cao C, Ouyang L, Ding Y, Wang D, Zheng M, Liao Z, Yue S, Liao W. A Novel Nomogram Based on Quantitative MRI and Clinical Features for the Prediction of Neonatal Intracranial Hypertension. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1582. [PMID: 37892245 PMCID: PMC10605298 DOI: 10.3390/children10101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 10/29/2023]
Abstract
Intracranial hypertension (ICH) is a serious threat to the health of neonates. However, early and accurate diagnosis of neonatal intracranial hypertension remains a major challenge in clinical practice. In this study, a predictive model based on quantitative magnetic resonance imaging (MRI) data and clinical parameters was developed to identify neonates with a high risk of ICH. Newborns who were suspected of having intracranial lesions were included in our study. We utilized quantitative MRI to obtain the volumetric data of gray matter, white matter, and cerebrospinal fluid. After the MRI examination, a lumbar puncture was performed. The nomogram was constructed by incorporating the volumetric data and clinical features by multivariable logistic regression. The performance of the nomogram was evaluated by discrimination, calibration curve, and decision curve. Clinical parameters and volumetric quantitative MRI data, including postmenstrual age (p = 0.06), weight (p = 0.02), mode of delivery (p = 0.01), and gray matter volume (p = 0.003), were included in and significantly associated with neonatal intracranial hypertension risk. The nomogram showed satisfactory discrimination, with an area under the curve of 0.761. Our results demonstrated that decision curve analysis had promising clinical utility of the nomogram. The nomogram, incorporating clinical and quantitative MRI features, provided an individualized prediction of neonatal intracranial hypertension risk and facilitated decision making guidance for the early diagnosis and treatment for neonatal ICH. External validation from studies using a larger sample size before implementation in the clinical decision-making process is needed.
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Affiliation(s)
- Yan Qin
- Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Yang Liu
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China (S.Y.)
| | - Chuanding Cao
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China (S.Y.)
| | - Lirong Ouyang
- Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Ying Ding
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China (S.Y.)
| | - Dongcui Wang
- Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Mengqiu Zheng
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China (S.Y.)
| | - Zhengchang Liao
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China (S.Y.)
| | - Shaojie Yue
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China (S.Y.)
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
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Chen F, Zhang S, Li B, Zhang J, Ran M, Qi B. A review of invasive intracranial pressure monitoring following surgery for hypertensive cerebral hemorrhage. Front Neurol 2023; 14:1108722. [PMID: 37470003 PMCID: PMC10353852 DOI: 10.3389/fneur.2023.1108722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
Hypertensive cerebral hemorrhage, the most common prevalent of spontaneous cerebral hemorrhage, poses a significant threat to patient mortality and morbidity, while therapeutic options remain limited, making the disease a burden not only for patients' families but also a major challenge for national healthcare systems. The elevation of intracranial pressure subsequent to hypertensive cerebral hemorrhage is a critical contributor to mortality. However, it often manifests before the onset of clinical symptoms, which are typically atypical, leading to delayed treatment and irreversible consequences for the patient. Hence, early detection of intracranial pressure variations can aid in timely, efficient, and precise treatment, reducing patient mortality. Invasive intracranial pressure monitoring enables real-time, accurate monitoring of intracranial pressure changes, providing clinicians with therapeutic guidance and overcoming the limitations of empirical treatment. This article aims to review the use of invasive intracranial pressure monitoring in postoperative hypertensive cerebral hemorrhage and hopes to contribute to clinical and scientific research.
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Affiliation(s)
- Fu Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Shukui Zhang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Bingzhen Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jin Zhang
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Maoxin Ran
- Department of Hepatobiliary Surgery, Zhijin County People's Hospital, Bijie, China
| | - Bin Qi
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Pelah AI, Zakrzewska A, Calviello LA, Forcht Dagi T, Czosnyka Z, Czosnyka M. Accuracy of Intracranial Pressure Monitoring-Single Centre Observational Study and Literature Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3397. [PMID: 37050457 PMCID: PMC10098789 DOI: 10.3390/s23073397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
Intracranial hypertension and adequacy of brain blood flow are primary concerns following traumatic brain injury. Intracranial pressure (ICP) monitoring is a critical diagnostic tool in neurocritical care. However, all ICP sensors, irrespective of design, are subject to systematic and random measurement inaccuracies that can affect patient care if overlooked or disregarded. The wide choice of sensors available to surgeons raises questions about performance and suitability for treatment. This observational study offers a critical review of the clinical and experimental assessment of ICP sensor accuracy and comments on the relationship between actual clinical performance, bench testing, and manufacturer specifications. Critically, on this basis, the study offers guidelines for the selection of ICP monitoring technologies, an important clinical decision. To complement this, a literature review on important ICP monitoring considerations was included. This study utilises illustrative clinical and laboratory material from 1200 TBI patients (collected from 1992 to 2019) to present several important points regarding the accuracy of in vivo implementation of contemporary ICP transducers. In addition, a thorough literature search was performed, with sources dating from 1960 to 2021. Sources considered to be relevant matched the keywords: "intraparenchymal ICP sensors", "fiberoptic ICP sensors", "piezoelectric strain gauge sensors", "external ventricular drains", "CSF reference pressure", "ICP zero drift", and "ICP measurement accuracy". Based on single centre observations and the 76 sources reviewed in this paper, this material reports an overall anticipated measurement accuracy for intraparenchymal transducers of around ± 6.0 mm Hg with an average zero drift of <2.0 mm Hg. Precise ICP monitoring is a key tenet of neurocritical care, and accounting for zero drift is vital. Intraparenchymal piezoelectric strain gauge sensors are commonly implanted to monitor ICP. Laboratory bench testing results can differ from in vivo observations, revealing the shortcomings of current ICP sensors.
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Affiliation(s)
- Adam I. Pelah
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Agnieszka Zakrzewska
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Leanne A. Calviello
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Teodoro Forcht Dagi
- Neurosurgery, Mayo School of Medicine and Science, Rochester, MN 55905, USA
- School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast BT7 1NN, UK
| | - Zofia Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
- Institute of Electronic Systems, Warsaw University of Technology, 00-65 Warszawa, Poland
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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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6
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Tabassum S, Ruesch A, Acharya D, Yang J, Relander FAJ, Scammon B, Wolf MS, Rakkar J, Clark RSB, McDowell MM, Kainerstorfer JM. Clinical translation of noninvasive intracranial pressure sensing with diffuse correlation spectroscopy. J Neurosurg 2022:1-10. [PMID: 36683191 DOI: 10.3171/2022.9.jns221203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Intracranial pressure (ICP) is an important therapeutic target in many critical neuropathologies. The current tools for ICP measurements are invasive; hence, these are only selectively applied in critical cases where the benefits surpass the risks. To address the need for low-risk ICP monitoring, the authors developed a noninvasive alternative. METHODS The authors recently demonstrated noninvasive quantification of ICP in an animal model by using morphological analysis of microvascular cerebral blood flow (CBF) measured with diffuse correlation spectroscopy (DCS). The current prospective observational study expanded on this preclinical study by translating the method to pediatric patients. Here, the CBF features, along with mean arterial pressure (MAP) and heart rate (HR) data, were used to build a random decision forest, machine learning model for estimation of ICP; the results of this model were compared with those of invasive monitoring. RESULTS Fifteen patients (mean age ± SD [range] 9.8 ± 5.1 [0.3-17.5] years; median age [interquartile range] 11 [7.4] years; 10 males and 5 females) who underwent invasive neuromonitoring for any purpose were enrolled. Estimated ICP (ICPest) very closely matched invasive ICP (ICPinv), with a root mean square error (RMSE) of 1.01 mm Hg and 95% limit of agreement of ≤ 1.99 mm Hg for ICPinv 0.01-41.25 mm Hg. When the ICP range (ICPinv 0.01-29.05 mm Hg) was narrowed on the basis of the sample population, both RMSE and limit of agreement improved to 0.81 mm Hg and ≤ 1.6 mm Hg, respectively. In addition, 0.3% of the test samples for ICPinv ≤ 20 mm Hg and 5.4% of the test samples for ICPinv > 20 mm Hg had a limit of agreement > 5 mm Hg, which may be considered the acceptable limit of agreement for clinical validity of ICP sensing. For the narrower case, 0.1% of test samples for ICPinv ≤ 20 mm Hg and 1.1% of the test samples for ICPinv > 20 mm Hg had a limit of agreement > 5 mm Hg. Although the CBF features were crucial, the best prediction accuracy was achieved when these features were combined with MAP and HR data. Lastly, preliminary leave-one-out analysis showed model accuracy with an RMSE of 6 mm Hg and limit of agreement of ≤ 7 mm Hg. CONCLUSIONS The authors have shown that DCS may enable ICP monitoring with additional clinical validation. The lower risk of such monitoring would allow ICP to be estimated for a wide spectrum of indications, thereby both reducing the use of invasive monitors and increasing the types of patients who may benefit from ICP-directed therapies.
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Affiliation(s)
- Syeda Tabassum
- 1Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh
| | - Alexander Ruesch
- 1Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh.,4Neuroscience Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Deepshikha Acharya
- 1Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh
| | - Jason Yang
- 1Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh
| | - Filip A J Relander
- 1Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh
| | - Bradley Scammon
- 1Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh
| | - Michael S Wolf
- 2Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh
| | - Jaskaran Rakkar
- 2Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh
| | - Robert S B Clark
- 2Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh
| | - Michael M McDowell
- 3Division of Neurological Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh; and
| | - Jana M Kainerstorfer
- 1Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh.,4Neuroscience Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania
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El-Swaify ST, Kamel M, Ali SH, Bahaa B, Refaat MA, Amir A, Abdelrazek A, Beshay PW, Basha AKMM. Initial neurocritical care of severe traumatic brain injury: New paradigms and old challenges. Surg Neurol Int 2022; 13:431. [DOI: 10.25259/sni_609_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/29/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Early neurocritical care aims to ameliorate secondary traumatic brain injury (TBI) and improve neural salvage. Increased engagement of neurosurgeons in neurocritical care is warranted as daily briefings between the intensivist and the neurosurgeon are considered a quality indicator for TBI care. Hence, neurosurgeons should be aware of the latest evidence in the neurocritical care of severe TBI (sTBI).
Methods:
We conducted a narrative literature review of bibliographic databases (PubMed and Scopus) to examine recent research of sTBI.
Results:
This review has several take-away messages. The concept of critical neuroworsening and its possible causes is discussed. Static thresholds of intracranial pressure (ICP) and cerebral perfusion pressure may not be optimal for all patients. The use of dynamic cerebrovascular reactivity indices such as the pressure reactivity index can facilitate individualized treatment decisions. The use of ICP monitoring to tailor treatment of intracranial hypertension (IHT) is not routinely feasible. Different guidelines have been formulated for different scenarios. Accordingly, we propose an integrated algorithm for ICP management in sTBI patients in different resource settings. Although hyperosmolar therapy and decompressive craniectomy are standard treatments for IHT, there is a lack high-quality evidence on how to use them. A discussion of the advantages and disadvantages of invasive ICP monitoring is included in the study. Addition of beta-blocker, anti-seizure, and anticoagulant medications to standardized management protocols (SMPs) should be considered with careful patient selection.
Conclusion:
Despite consolidated research efforts in the refinement of SMPs, there are still many unanswered questions and novel research opportunities for sTBI care.
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Affiliation(s)
- Seif Tarek El-Swaify
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Menna Kamel
- School of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sara Hassan Ali
- School of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Bassem Bahaa
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Abdelrahman Amir
- School of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Pavly Wagih Beshay
- School of Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Hu X, Tian J, Xie J, Zheng S, Wei L, Zhao L, Wang S. Predictive role of shock index in the early formation of cerebral infarction in patients with TBI and cerebral herniation. Front Neurol 2022; 13:956039. [PMID: 36090875 PMCID: PMC9454297 DOI: 10.3389/fneur.2022.956039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeTraumatic brain injury (TBI) with brain herniation predisposes to posttraumatic cerebral infarction (PTCI), which in turn seriously affects the prognosis of patients. At present, there is a lack of effective indicators that can accurately predict the occurrence of PTCI. We aimed to find possible risk factors for the development of PTCI by comparing the preoperative and postoperative clinical data of TBI patients with brain herniation.MethodsThe clinical data of 120 patients with craniocerebral trauma and brain herniation were retrospectively analyzed. Among them, 54 patients had cerebral infarction within 3–7 days after injury. The two groups of patients were compared through univariate and multivariate logistic regression analysis, and a classification tree model and a nomogram model were constructed. Finally, receiver operating characteristic curve analysis and decision curve analysis were conducted to analyze the clinical utility of the prediction model.ResultsLogistic regression analysis showed that factors like the Glasgow Coma Scale (GCS) score (P = 0.002), subarachnoid hemorrhage (SAH) (P = 0.005), aspiration pneumonia (P < 0.001), decompressive craniectomy (P < 0.05), intracranial pressure (ICP) monitoring (P = 0.006), the shock index (SI) (P < 0.001), the mean arterial pressure (MAP) (P = 0.005), and blood glucose (GLU) (P < 0.011) appeared to show a significant statistical correlation with the occurrence of infarction (P < 0.05), while age, sex, body temperature (T), D-dimer levels, and coagulation tests were not significantly correlated with PTCI after cerebral herniation. Combined with the above factors, Classification and Regression Tree was established, and the recognition accuracy rate reached 76.67%.ConclusionsGCS score at admission, no decompressive craniectomy, no ICP monitoring, combined SAH, combined aspiration pneumonia, SI, MAP, and high GLU were risk factors for infarction, of which SI was the primary predictor of PTCI in TBI with an area under the curve of 0.775 (95% CI = 0.689–0.861). Further large-scale studies are needed to confirm these results.
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Liu J, Shan Y, Gao G. The application value of CT radiomics features in predicting pressure amplitude correlation index in patients with severe traumatic brain injury. Front Neurol 2022; 13:905655. [PMID: 36090879 PMCID: PMC9454300 DOI: 10.3389/fneur.2022.905655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To explore the application value of a machine learning model based on CT radiomics features in predicting the pressure amplitude correlation index (RAP) in patients with severe traumatic brain injury (sTBI). Methods Retrospectively analyzed the clinical and imaging data in 36 patients with sTBI. All patients underwent surgical treatment, continuous ICP monitoring, and invasive arterial pressure monitoring. The pressure amplitude correlation index (RAP) was collected within 1 h after surgery. Three volume of interest (VOI) was selected from the craniocerebral CT images of patients 1 h after surgery, and a total of 93 radiomics features were extracted from each VOI. Three models were established to be used to evaluate the patients' RAP levels. The accuracy, precision, recall rate, F1 score, receiver operating characteristic (ROC) curve, and area under the curve (AUC) were used to evaluate the predictive performance of each model. Results The optimal number of features for three predicting models of RAP was five, respectively. The accuracy of predicting the model of the hippocampus was 77.78%, precision was 88.24%, recall rate was 60%, the F1 score was 0.6, and AUC was 0.88. The accuracy of predicting the model of the brainstem was 63.64%, precision was 58.33%, the recall rate was 60%, the F1 score was 0.54, and AUC was 0.82. The accuracy of predicting the model of the thalamus was 81.82%, precision was 88.89%, recall rate was 75%, the F1 score was 0.77, and AUC was 0.96. Conclusions CT radiomics can predict RAP levels in patients with sTBI, which has the potential to establish a method of non-invasive intracranial pressure (NI-ICP) monitoring.
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Affiliation(s)
- Jiaqi Liu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingchi Shan
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoyi Gao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Guoyi Gao
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Suarez-Meade P, Marenco-Hillembrand L, Sherman WJ. Neuro-oncologic Emergencies. Curr Oncol Rep 2022; 24:975-984. [PMID: 35353348 DOI: 10.1007/s11912-022-01259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Patients with brain and spine tumors are at high risk of presenting cancer-related complications at disease presentation or during active treatment and are usually related to the type and location of the lesion. Here, we discuss presentation and management of the most common emergencies affecting patients with central nervous system neoplastic lesions. RECENT FINDINGS Tumor-related emergencies encompass complications in patients with central nervous system neoplasms, as well as neurologic complications in patients with systemic malignancies. Brain tumor patients are at high risk of developing multiple complications such as intracranial hypertension, brain herniation, intracranial bleeding, spinal cord compression, and others. Neuro-oncologic emergencies require immediate attention and multi-disciplinary care. These emergent situations usually need rapid decision-making and management on an inpatient basis.
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Affiliation(s)
| | | | - Wendy J Sherman
- Department of Neurology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
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11
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Li J, Wan C. Non-invasive detection of intracranial pressure related to the optic nerve. Quant Imaging Med Surg 2021; 11:2823-2836. [PMID: 34079745 DOI: 10.21037/qims-20-1188] [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: 11/06/2022]
Abstract
Intracranial pressure (ICP) is associated with a variety of diseases. Early diagnosis and the timely intervention of elevated ICP are effective means to clinically reduce the morbidity and mortality of some diseases. The detection and judgment of reduced ICP are beneficial to glaucoma doctor and neuro ophthalmologist to diagnose optic nerve disease earlier. It is important to evaluate and monitor ICP clinically. Although invasive ICP detection is the gold standard, it can have complications. Most non-invasive ICP tests are related to the optic nerve and surrounding tissues due to their anatomical characteristics. Ultrasound, magnetic resonance imaging, transcranial Doppler, papilledema on optical coherence tomography, visual evoked potential, ophthalmodynamometry, the assessment of spontaneous retinal venous pulsations, and eye-tracking have potential for application. Although none of these methods can completely replace invasive technology; however, its repeatable, low risk, high accuracy, gradually attracted people's attention. This review summarizes the non-invasive ICP detection methods related to the optic nerve and the role of the diagnosis and prognosis of neurological disorders and glaucoma. We discuss the advantages and challenges and predict possible areas of development in the future.
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Affiliation(s)
- Jian Li
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China
| | - Chao Wan
- Department of Ophthalmology, the First Hospital of China Medical University, Shenyang, China
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12
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Rao HM, Yuditskaya S, Williamson JR, Vian TR, Lacirignola JJ, Shenk TE, Talavage TM, Heaton KJ, Quatieri TF. Using Oculomotor Features to Predict Changes in Optic Nerve Sheath Diameter and ImPACT Scores From Contact-Sport Athletes. Front Neurol 2021; 12:584684. [PMID: 33746869 PMCID: PMC7969804 DOI: 10.3389/fneur.2021.584684] [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: 07/17/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
There is mounting evidence linking the cumulative effects of repetitive head impacts to neuro-degenerative conditions. Robust clinical assessment tools to identify mild traumatic brain injuries are needed to assist with timely diagnosis for return-to-field decisions and appropriately guide rehabilitation. The focus of the present study is to investigate the potential for oculomotor features to complement existing diagnostic tools, such as measurements of Optic Nerve Sheath Diameter (ONSD) and Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). Thirty-one high school American football and soccer athletes were tracked through the course of a sports season. Given the high risk of repetitive head impacts associated with both soccer and football, our hypotheses were that (1) ONSD and ImPACT scores would worsen through the season and (2) oculomotor features would effectively capture both neurophysiological changes reflected by ONSD and neuro-functional status assessed via ImPACT. Oculomotor features were used as input to Linear Mixed-Effects Regression models to predict ONSD and ImPACT scores as outcomes. Prediction accuracy was evaluated to identify explicit relationships between eye movements, ONSD, and ImPACT scores. Significant Pearson correlations were observed between predicted and actual outcomes for ONSD (Raw = 0.70; Normalized = 0.45) and for ImPACT (Raw = 0.86; Normalized = 0.71), demonstrating the capability of oculomotor features to capture neurological changes detected by both ONSD and ImPACT. The most predictive features were found to relate to motor control and visual-motor processing. In future work, oculomotor models, linking neural structures to oculomotor function, can be built to gain extended mechanistic insights into neurophysiological changes observed through seasons of participation in contact sports.
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Affiliation(s)
- Hrishikesh M Rao
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Sophia Yuditskaya
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - James R Williamson
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Trina R Vian
- Counter-Weapons of Mass Destruction Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Joseph J Lacirignola
- Counter-Weapons of Mass Destruction Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Trey E Shenk
- Advanced Radio Frequency Techniques & Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Thomas M Talavage
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States.,Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
| | - Kristin J Heaton
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Thomas F Quatieri
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
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13
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Roldán M, Abay TY, Kyriacou PA. Non-Invasive Techniques for Multimodal Monitoring in Traumatic Brain Injury: Systematic Review and Meta-Analysis. J Neurotrauma 2020; 37:2445-2453. [DOI: 10.1089/neu.2020.7266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- María Roldán
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences, and Engineering, City University of London, London, United Kingdom
| | - Tomas Ysehak Abay
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences, and Engineering, City University of London, London, United Kingdom
| | - Panayiotis A. Kyriacou
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences, and Engineering, City University of London, London, United Kingdom
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14
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Gurney JM, Loos PE, Prins M, Van Wyck DW, McCafferty RR, Marion DW. The Prehospital Evaluation and Care of Moderate/Severe TBI in the Austere Environment. Mil Med 2020; 185:148-153. [PMID: 32074372 DOI: 10.1093/milmed/usz361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Increased resource constraints secondary to a smaller medical footprint, prolonged evacuation times, or overwhelming casualty volumes all increase the challenges of effective management of traumatic brain injury (TBI) in the austere environment. Prehospital providers are responsible for the battlefield recognition and initial management of TBI. As such, targeted education is critical to efficient injury recognition, promoting both provider readiness and improved patient outcomes. When austere conditions limit or prevent definitive treatment, a comprehensive understanding of TBI pathophysiology can help inform acute care and enhance prevention of secondary brain injury. Field deployable, noninvasive TBI assessment and monitoring devices are urgently needed and are currently undergoing clinical evaluation. Evidence shows that the assessment, monitoring, and treatment in the first few hours and days after injury should focus on the preservation of cerebral perfusion and oxygenation. For cases where medical management is inadequate (eg, evidence of an enlarging intracranial hematoma), guidelines have been developed for the performance of cranial surgery by nonneurosurgeons. TBI management in the austere environment will continue to be a challenge, but research focused on improving evidence-based monitoring and therapeutic interventions can help to mitigate some of these challenges and improve patient outcomes.
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Affiliation(s)
- Jennifer M Gurney
- Joint Trauma System/U.S. Army Institute of Surgical Research, 3698 Chambers Pass, San Antonio, TX 78234
| | - Paul E Loos
- Non-Standard Medical Detachment, Office of Strategic Warfare, 1st Special Forces Command, Fort Bragg, NC 28310
| | - Mayumi Prins
- Department of Neurosurgery, UCLA, 300 Stein Plaza Suite 532, Los Angeles, CA 90095
| | | | - Randall R McCafferty
- San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234
| | - Donald W Marion
- The Defense and Veterans Brain Injury Center and General Dynamics Information Technology, 1335 East West Hwy, Silver Spring, MD 20910
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15
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Wojcik P, Batliwala S, Rowsey T, Galdamez LA, Lee AG. Spaceflight-Associated Neuro-ocular Syndrome (SANS): a review of proposed mechanisms and analogs. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1787155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Peter Wojcik
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Shehzad Batliwala
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Tyler Rowsey
- College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Laura A. Galdamez
- Department of Emergency Medicine, Memorial Hermann The Woodlands, Shenandoah, TX, USA
| | - Andrew G. Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A and M College of Medicine, Bryan, TX, USA
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16
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Fischer JB, Ghouse A, Tagliabue S, Maruccia F, Rey-Perez A, Báguena M, Cano P, Zucca R, Weigel UM, Sahuquillo J, Poca MA, Durduran T. Non-Invasive Estimation of Intracranial Pressure by Diffuse Optics: A Proof-of-Concept Study. J Neurotrauma 2020; 37:2569-2579. [PMID: 32460617 DOI: 10.1089/neu.2019.6965] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Intracranial pressure (ICP) is an important parameter to monitor in several neuropathologies. However, because current clinically accepted methods are invasive, its monitoring is limited to patients in critical conditions. On the other hand, there are other less critical conditions for which ICP monitoring could still be useful; therefore, there is a need to develop non-invasive methods. We propose a new method to estimate ICP based on the analysis of the non-invasive measurement of pulsatile, microvascular cerebral blood flow with diffuse correlation spectroscopy. This is achieved by training a recurrent neural network using only the cerebral blood flow as the input. The method is validated using a 50% split sample method using the data from a proof-of-concept study. The study involved a population of infants (n = 6) with external hydrocephalus (initially diagnosed as benign enlargement of subarachnoid spaces) as well as a population of adults (n = 6) with traumatic brain injury. The algorithm was applied to each cohort individually to obtain a model and an ICP estimate. In both diverse cohorts, the non-invasive estimation of ICP was achieved with an accuracy of <4 mm Hg and a negligible small bias. Further, we have achieved a good correlation (Pearson's correlation coefficient >0.9) and good concordance (Lin's concordance correlation coefficient >0.9) in comparison with standard clinical, invasive ICP monitoring. This preliminary work paves the way for further investigations of this tool for the non-invasive, bedside assessment of ICP.
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Affiliation(s)
- Jonas B Fischer
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain.,HemoPhotonics S.L., Castelldefels, Barcelona, Spain
| | - Ameer Ghouse
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Susanna Tagliabue
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Federica Maruccia
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain.,Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rey-Perez
- Neurotrauma Intensive Care Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marcelino Báguena
- Neurotrauma Intensive Care Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paola Cano
- Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Riccardo Zucca
- Synthetic Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Udo M Weigel
- HemoPhotonics S.L., Castelldefels, Barcelona, Spain
| | - Juan Sahuquillo
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria A Poca
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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17
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Goto T, Furihata K, Hongo K. Natural resonance frequency of the brain depends on only intracranial pressure: clinical research. Sci Rep 2020; 10:2526. [PMID: 32054904 PMCID: PMC7018690 DOI: 10.1038/s41598-020-59376-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/28/2020] [Indexed: 11/20/2022] Open
Abstract
To understand and control intracranial pressure (ICP) is required for treatments in various clinical situations. To establish non-invasive ICP prediction method, we focused on the natural resonance frequency (NRF) of the brain. The ICP value, pulse waveform of intracranial pressure (PWICP) and cervical carotid pulse waveform (CCPW) were simultaneously collected from patients who underwent neurosurgical treatment. A total of 43 data were obtained from 27 patients. The total measured time was 29,653 seconds and the measured mean ICP value in each data ranged from 3.82 to 69.39 (mean 25.9) hPa. Respiratory synchronized cardiac pulses were selected and following CCPW and PWICP were collected. The transfer characteristics from collected CCPW to PWICP were calculated. The initial negative peak was judged as the NRF of the brain. The relationship between the ICP value and the NRF of the brain was presented on the quadratic functions graph (ICP = 0.0329(NRF)2 + 0.0842NRF; R2 = 0.9952). It means that the individual NRF only depends on their ICP value. The ICP value will be predicted by checking NRF of the brain from somewhere.
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Affiliation(s)
- Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenji Furihata
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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18
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Kerscher SR, Schöni D, Neunhoeffer F, Wolff M, Haas-Lude K, Bevot A, Schuhmann MU. The relation of optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in pediatric neurosurgery practice - Part II: Influence of wakefulness, method of ICP measurement, intra-individual ONSD-ICP correlation and changes after therapy. Childs Nerv Syst 2020; 36:107-115. [PMID: 31392457 DOI: 10.1007/s00381-019-04336-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/30/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Previous studies correlating ultrasound (US)-based optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in children were performed under general anesthesia. To apply ONSD in daily clinical routine, it is necessary to investigate patients awake. It is furthermore essential for ICP-assessment with ONSD to know if ONSD-ICP correlation varies within individuals. In this study, we report on the influence of wakefulness, method of ICP measurement, intraindividual correlations, and dynamic changes of ONSD and ICP after ICP decreasing therapy. METHODS The overall study included 72 children with a median age of 5.2 years. US ONSD determination was performed immediately prior to invasive ICP measurement, and the mean binocular ONSD was compared to ICP. In 10 children, a minimum of 3 ONSD/ICP measurements were performed to investigate a correlation within subjects. In 30 children, measurements were performed before and after therapy. RESULTS Twenty-eight children were investigated awake with an excellent correlation of ONSD and ICP (r = 0.802, p < 0.01). In 10 children, at least three simultaneous ONSD and ICP measurements were performed. The intraindividual correlations were excellent (r = 0.795-1.0) however with strongly differing individual regression curves. The overall correlation within subjects was strong (r = 0.78, p < 0.01). After ICP decreasing therapy, all ONSD values decreased significantly (p < 0.01); however, there was no correlation between ∆ICP and ∆ONSD. CONCLUSION Awake investigation does not impair the correlation between ONSD and ICP. Even if there is a good overall ONSD-ICP correlation, every individual has its own distinctive and precise correlation line. The relationship between ONSD and ICP is furthermore not uniform between individuals. Strong ICP decreases can lead to smaller ONSD changes and vice versa. This should be kept in mind when using this technique in the clinical daily routine.
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Affiliation(s)
- Susanne R Kerscher
- Department of Neurosurgery, Pediatric Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany.
- Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany.
| | - Daniel Schöni
- Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
- Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland
| | - Felix Neunhoeffer
- Pediatric Intensive Care Unit, Childrens' Hospital, University Hospital of Tuebingen, Tuebingen, Germany
| | - Markus Wolff
- Department of Pediatric Neurology and Developmental Medicine, Childrens' Hospital, University Hospital of Tuebingen, Tuebingen, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, Childrens' Hospital, University Hospital of Tuebingen, Tuebingen, Germany
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, Childrens' Hospital, University Hospital of Tuebingen, Tuebingen, Germany
| | - Martin U Schuhmann
- Department of Neurosurgery, Pediatric Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany
- Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
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19
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Padayachy LC, Robba C, Brekken R. Non-invasive assessment of ICP in children: advances in ultrasound-based techniques. Childs Nerv Syst 2020; 36:95-98. [PMID: 31584121 DOI: 10.1007/s00381-019-04371-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022]
Abstract
The assessment of intracranial pressure (ICP) in children with neurological disease remains a cornerstone in their routine management. The quest for a reliable, reproducible and radiation-free non-invasive technique for assessing ICP in children remains somewhat of a holy grail for neurosurgery. This work assesses some of the recent advances in ultrasound-based techniques, addressing both novel processes and modifications aimed at improving the accuracy of existing techniques.
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Affiliation(s)
- Llewellyn C Padayachy
- Department of Neurosurgery, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.
| | - C Robba
- Department of Anaesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Largo Rosanna Benzi, 15, 16100, Genoa, Italy
| | - R Brekken
- Department of Health Research, Medical Technology, SINTEF, Trondheim, Norway
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20
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Transcranial Shear Wave Elastography of Neonatal and Infant Brains for Quantitative Evaluation of Increased Intracranial Pressure. Invest Radiol 2019; 54:719-727. [DOI: 10.1097/rli.0000000000000602] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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M Imaduddin S, Fanelli A, Vonberg FW, Tasker RC, Heldt T. Pseudo-Bayesian Model-Based Noninvasive Intracranial Pressure Estimation and Tracking. IEEE Trans Biomed Eng 2019; 67:1604-1615. [PMID: 31535978 DOI: 10.1109/tbme.2019.2940929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE A noninvasive intracranial pressure (ICP) estimation method is proposed that incorporates a model-based approach within a probabilistic framework to mitigate the effects of data and modeling uncertainties. METHODS A first-order model of the cerebral vasculature relates measured arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV) to ICP. The model is driven by the ABP waveform and is solved for a range of mean ICP values to predict the CBFV waveform. The resulting errors between measured and predicted CBFV are transformed into likelihoods for each candidate ICP in two steps. First, a baseline ICP estimate is established over five data windows of 20 beats by combining the likelihoods with a prior distribution of the ICP to yield an a posteriori distribution whose median is taken as the baseline ICP estimate. A single-state model of cerebral autoregulatory dynamics is then employed in subsequent data windows to track changes in the baseline by combining ICP estimates obtained with a uniform prior belief and model-predicted ICP. For each data window, the estimated model parameters are also used to determine the ICP pulse pressure. RESULTS On a dataset of thirteen pediatric patients with a variety of pathological conditions requiring invasive ICP monitoring, the method yielded for mean ICP estimation a bias (mean error) of 0.6 mmHg and a root-mean-squared error of 3.7 mmHg. CONCLUSION These performance characteristics are well within the acceptable range for clinical decision making. SIGNIFICANCE The method proposed here constitutes a significant step towards robust, continuous, patient-specific noninvasive ICP determination.
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Abstract
This review provides a summary of the literature pertaining to the perioperative care of neurosurgical patients and patients with neurological diseases. General topics addressed in this review include general neurosurgical considerations, stroke, traumatic brain injury, neuromonitoring, neurotoxicity, and perioperative disorders of cognitive function.
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