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Microdialysis in traumatic brain injury — methodology and pathophysiology

  • Conference paper
Intracranial Pressure and Brain Monitoring XII

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 95))

Summary

The application of clinical microdialysis to monitor changes in cerebral extracellular chemistry is now well established in several neurosurgical units worldwide. In neuro-intensive care the technique has been predominantly applied to patients with traumatic brain injury and subarachnoid haemorrhage. There is no doubt that microdialysis has increased and continues to increase our understanding of the pathophysiology of these conditions. Current studies are addressing the potential role of microdialysis as a clinical monitoring technique assisting in the management of patients on an intention to treat basis. This involves establishing the relationship between microdialysis and outcome, and the effect of therapeutic manoeuvres on the chemistry. This manuscript describes the place of microdialysis in traumatic brain injury in terms of the fundamental principles, methodology, pathophysiology and clinical application.

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References

  1. Bellander BMCE, Enblad P, Hutchinson P, Nordstrom CH, Robertson C, Sahuquillo J, Smith M, Stocchetti N, Ungerstedt U, Unterberg A, Olsen NV (2004) Consensus meeting on microdialysis in neurointensive care. Int Care Med (in press)

    Google Scholar 

  2. Benveniste H (1989) Brain microdialysis. J Neurochem 52: 1667–1679

    PubMed  CAS  Google Scholar 

  3. Benveniste H, Diemer NH (1988) Early postischaemic 45Ca accumulation in rat dentate hilus. J Cereb Blood Flow Metab 8: 713–719

    PubMed  CAS  Google Scholar 

  4. Benveniste H, Drejer J, Schousboe A, Diemer NH (1987) Regional cerebral glucose phosphorylation and blood flow after insertion of a microdialysis fibre through the dorsal hippocampus in the rat. J Neurochem 49: 729–734

    PubMed  CAS  Google Scholar 

  5. Brain Trauma Foundation (2003) American Association of Neurological Surgeons. Guidelines for the management of severe head injury. J Neurotrauma 13: 641–734

    Google Scholar 

  6. Bullock R, Zauner A, Woodward JJ, Myseros JS, Choi SC, Ward JD, Marmarou A, Young HF (1998) Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg 89: 507–518

    PubMed  CAS  Google Scholar 

  7. Goodman JC, Valadka AB, Gopinath SP, Cormio M, Robertson CS (1996) Lactate and excitatory amino acids measured by microdialysis are decreased by pentobarbital coma in head-injured patients. J Neurotrauma 13: 549–556

    PubMed  CAS  Google Scholar 

  8. Goodman JC, Valadka AB, Gopinath SP, Uzura M, Robertson CS (1999) Extracellular lactate and glucose alterations in the brain after head injury measured by microdialysis. Crit Care Med 27: 1965–1973

    Article  PubMed  CAS  Google Scholar 

  9. Hlatky R, Valadka AB, Goodman JC, Contant CF, Robertson CS (2004) Patterns of energy substrates during ischaemia measured in the brain by microdialysis. J Neurotrauma 21: 894–906

    Article  PubMed  Google Scholar 

  10. Hlatky R, Valadka AB, Goodman JC, Robertson CS (2004) Evolution of brain tissue injury after evacuation of acute traumatic subdural haematomas. Neurosurgery 55: 1318–1323

    Article  PubMed  Google Scholar 

  11. Hutchinson PJ, Gupta AK, Fryer TF, Al-Rawi PG, Chatfield DA, Coles JP, O’Connell MT, Kett-White R, Minhas PS, Aigbirhio F, Clark JC, Kirkpatrick PJ, Menon DK, Pickard JD (2002) Correlation between cerebral blood flow, substrate delivery, and metabolism in head injury: a combined microdialysis and triple oxygen positron emission tomography study. J Cereb Blood Flow Metab 22: 735–745

    Article  PubMed  Google Scholar 

  12. Hutchinson PJ, O’Connell MT, Al-Rawi PG, Maskell LB, Kett-White CR, Gupta AK, Richards HK, Hutchinson DB, Kirkpatrick PJ, Pickard JD (2000) Clinical cerebral microdialysis — a methodological study. J Neurosurg 93: 37–43

    PubMed  CAS  Google Scholar 

  13. Hutchinson PJA, O’Connell MT, Al-Rawi PG, Maskell LB, Gupta AK, Hutchinson DBA, Pickard JD, Kirkpatrick PJ, Wharton SB (1999) Neuropathological findings after microdialysis catheter implantation (letter). NeuroReport 10(3): i

    PubMed  CAS  Google Scholar 

  14. Johnston AJ, Steiner LA, Coles JP, Chatfield DA, Fryer TD, Smielewski P, Hutchinson PJ, O’Connell MT, Al-Rawi PG, Aigbirhio FI, Clark JC, Pickard JD, Gupta AK, Menon DK (2005) Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit Care Med 33: 189–195

    Article  PubMed  Google Scholar 

  15. Kett-White R, Hutchinson PJ, Czosnyka M, Boniface S, Pickard JD, Kirkpatrick PJ (2002) Multi-Modal Monitoring of Acute Brain Injury. Adv Tech Stand Neurosurg 27: 87–134.

    PubMed  CAS  Google Scholar 

  16. Maas AI, Dearden M, Teasdale GM, Braakman R, Cohadon F, Iannotti F, Karimi A, Lapierre F, Murray G, Ohman J, Persson L, Servadei F, Stocchetti N, Unterberg A (1997) EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir Wien 139: 286–294

    Article  PubMed  CAS  Google Scholar 

  17. Magnoni S, Ghisoni L, Locatelli M, Caimi M, Colombo A, Valerian V, Stocchetti N (2003) Lack of improvement in cerebral metabolism after hyperoxia in severe head injury: a microdialysis study. J Neurosurg 98: 952–958

    Article  PubMed  Google Scholar 

  18. Major O, Shdanova T, Duffek L, Nagy Z (1990) Continuous monitoring of blood-brain barrier opening to 51Cr-EDTA by microdialysis following probe injury. Acta Neurochir [Suppl] 51: 46–48

    CAS  Google Scholar 

  19. Marion DW, Puccio A, Wisniewski SR, Kochanek P, Dixon CE, Bullian L, Carlier P (2002) Effect of hyperventilation on extracellular concentrations of glutamate, lactate, pyruvate, and local cerebral blood flow in patients with traumatic brain injury. Crit Care Med 30: 2619–2625

    Article  PubMed  CAS  Google Scholar 

  20. Meyerson BA, Linderoth B, Karlsson H, Ungerstedt U (1990) Microdialysis in the human brain: extracellular measurements in the thalamus of parkinsonian patients. Life Sci 46: 301–308

    Article  PubMed  CAS  Google Scholar 

  21. Nelson DW, Bellander BM, Maccallum RM, Axelsson J, Alm M, Wallin M, Weitzberg E, Rudehill A (2004) Cerebral microdialysis of patients with severe traumatic brain injury exhibits highly individualistic patterns as visualised by cluster analysis with self-organising maps. Crit Care Med 2428–2436

    Google Scholar 

  22. Persson L, Hillered L (1992) Chemical monitoring of neurosurgical intensive care patients using intracerebral microdialysis. J Neurosurg 76: 72–80

    PubMed  CAS  Google Scholar 

  23. Sarrafzadeh AS, Kiening KL, Callsen TA, Unterberg AW (2003) Metabolic changes during impending and manifest cerebral hypoxia in traumatic brain injury. Br J Neurosurg 17: 340–346

    Article  PubMed  CAS  Google Scholar 

  24. Stahl N, Schalen W, Ungerstedt U, Nordstrom CH (2001) Bedside biochemical monitoring of the penumbra zone surrounding an evacuated acute subdural haematoma. Acta Neurol Scand 108: 211–215

    Article  Google Scholar 

  25. Stahl N, Ungerstedt U, Nordstrom CH (2001) Brain energy metabolism during controlled reduction of cerebral perfusion pressure in severe head injuries. Intensive Care Med 27: 1215–1223

    Article  PubMed  CAS  Google Scholar 

  26. Tolias CM, Reinert M, Seiler R, Gilman C, Scharf A, Bullock MR (2004) Normobaric hyperoxia-induced improvement in cerebral metabolism and reduction in intracranial pressure in patients with severe head injury: a prospective historical cohort-matched study. J Neurosurg 435–444

    Google Scholar 

  27. Ungerstedt U (1984) Measurement of neurotransmitter release by intracranial dialysis. In: Marsden CA (ed) Measurement of Neurotransmitter Release in vivo. John Wiley & Sons Ltd, Chichester, p 81–105

    Google Scholar 

  28. Ungerstedt U (1991) Microdialysis-principles and applications for studies in animals and man. J Intern Med 230: 365–373

    Article  PubMed  CAS  Google Scholar 

  29. Ungerstedt U, Pycock C (1974) Functional correlates of dopamine neurotransmission. Bull Schweiz Akad Med Wiss 30: 44–55

    PubMed  CAS  Google Scholar 

  30. Vespa P, Prins M, Ronne-Engstrom E, Caron M, Shalmon E, Hovda DA, Martin NA, Becker DP (1998) Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after traumatic brain injury: a microdialysis study. J Neurosurg 89: 971–982

    Article  PubMed  CAS  Google Scholar 

  31. Whittle IR, Glasby M, Lammie A, Ball H, Ungerstedt U (1998) Neuropathological findings after intracerebral implantation of microdialysis catheters. NeuroReport 9: 2821–2825

    PubMed  CAS  Google Scholar 

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Correspondence to P. J. Hutchinson .

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© 2005 Springer-Verlag

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Hutchinson, P.J. (2005). Microdialysis in traumatic brain injury — methodology and pathophysiology. In: Poon, W.S., et al. Intracranial Pressure and Brain Monitoring XII. Acta Neurochirurgica Supplementum, vol 95. Springer, Vienna. https://doi.org/10.1007/3-211-32318-X_91

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  • DOI: https://doi.org/10.1007/3-211-32318-X_91

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-24336-7

  • Online ISBN: 978-3-211-32318-2

  • eBook Packages: MedicineMedicine (R0)

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