Neurocritical Care

, Volume 4, Issue 1, pp 83–92 | Cite as

Neuromonitoring in neurological critical care

Perspectives in Brain Physiology

Abstract

In this article, we review technologies available for direct monitoring of cerebral oxygenation and metabolic status, including jugular venous oxygen saturation, brain tissue oxygen tension, transcranial cerebral oximetry with near-infrared spectroscopy, Positron emission tomography oxidative metabolism, single-photon emission computed tomography/computed tomography perfusion and functional imaging, and cerebral metabolite measurement using microdialysis. We also introduce a novel method of monitoring cerebral perfusion that may substitute for direct monitoring of oxygenation in the future.

Key Words

Neuromonitoring ICP SPECT PET ventriculostomy cerebral oximetry 

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References

  1. 1.
    The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Hyperventilation. J Neurotrauma 2000;17: 513–520.Google Scholar
  2. 2.
    The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Indictions for intracranial pressure monitoring. Neuroctrauma 2000;17:479–491.Google Scholar
  3. 3.
    The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Recommendations for intracranial pressure monitoring technology. J Neurotrauma 2000;17:497–506.Google Scholar
  4. 4.
    Abdel-Dayem HM, Abu-Judeh H, Kumar M, et al. SPECT brain perfusion abnormalities in mild or moderate traumatic brain injury. Clin Nucl Med 1992;23:309–317.CrossRefGoogle Scholar
  5. 5.
    Abu-Judeh HH, Parker R, Singh M, et al. SPET brain perfusion imaging in mild traumatic brain injury without loss of conscious-ness and normal computed tomography. Nucl Med Common 1992;20:505–510.CrossRefGoogle Scholar
  6. 6.
    Alavi A. Functional and anatomic studies of head injury.J Neuropsychiatry Clin Neurosci 1989;1:S45-S50.PubMedGoogle Scholar
  7. 7.
    Andrews PJ, Dearden NM, Miller JD. Jugular bulb cannulation: description of a cannulation technique and validation of a new continuous monitor. Br J Anaesth 1991;67:553–558.PubMedCrossRefGoogle Scholar
  8. 8.
    Andrews PJ, Piper IR, Dearden NM, et al. Secondary insults during intrathospital transport of head-injured patients. Lancet 1990;335:327–330.PubMedCrossRefGoogle Scholar
  9. 9.
    Bardt TF, Unterberg AW, Hartl R, et al. Monitoring of brain tissue PO2 in traumatic brain injury: effect of cerebral hypoxia on outcome. Acta Neurochir Suppl (Wien) 1998;71:153–156.Google Scholar
  10. 10.
    Bardt TF, Unterberg AW, Kiening KL, et al. Multimodal cerebral monitoring in comatose head-injured patients. Acta Neurochir (Wien) 1998;140:357–365.CrossRefGoogle Scholar
  11. 11.
    Barlow P, Mendelow AD, Lawrence AE, et al. Clinical evaluation of two methods of subdural pressure monitoring. J Neurosurg 1985;63:578–582.PubMedGoogle Scholar
  12. 12.
    Bavetta S, Norris JS, Wyatt M, et al. Prospectiver study of zero drift in fiberoptic pressure monitors used in clinica practice. J Neurosurg 1997;86:927–930.PubMedGoogle Scholar
  13. 13.
    Bavetta S, Sutcliffe JC, Sparrow OC, et al., A prospective comparison of fibre-optic and fluid-filled single lumen bolt subdural pressure transducers in ventilated neurosurgical patients. Br J Neurosurg 1996;10:279–284.PubMedCrossRefGoogle Scholar
  14. 14.
    Becker DP, Miller JD, Ward JD, et al. The outocome from severe head injury with early diagnosis and intensive management. J Neurosurg 1977;47:491–502.PubMedGoogle Scholar
  15. 15.
    Braih Trauma Foundation. American Association of Neurological Surgeons JSoNaCC: Management and Prognosis of Severe Traumatic Brain Injury. In: 2000.Google Scholar
  16. 16.
    Brunner M, Muller M. Microdialysis: an in vivo approach for measuring drug delivery in oncology. Eur J Clin Pharmacol 2002;58:227–234.PubMedCrossRefGoogle Scholar
  17. 17.
    Bloock R, Zauner A, Woodward JJ, et al. Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg 1998;89:507–518.Google Scholar
  18. 18.
    Chesnut RM. Secondary brain insults after head injury: clinical perspectives. New Horiz 1995;3:366–375.PubMedGoogle Scholar
  19. 19.
    Chesnutt RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993;34:216–222.Google Scholar
  20. 20.
    Chesnut RM, Marshall SB, Piek J, et al. Early and late systemic hypotension as a frequent and fudamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl (Wien) 1993;59:121–125.Google Scholar
  21. 21.
    Cormio M, Valadka AB, Robertson CS. Elevated jugular venous oxygen saturation after severe head injury. J Neurosurg 1999;90:9–15.PubMedGoogle Scholar
  22. 22.
    Cotran RS, Kumar V, Collins T et al. Robbins pathologic basic of disease, 6the ed. Philadelphia: Saunders, 1999.Google Scholar
  23. 23.
    Diaz-Reganon G, Minambres E, Holanda M, et al. Usefulness of venous oxygen saturation in the jugular bulb for the diagnosis of brain death: report of 118 patients. Intensive Care Med 2002;28:1724–1728.PubMedCrossRefGoogle Scholar
  24. 24.
    Dings J, Meixensberger J, Amschler J, et al. Continuous monitoring of brain tissue PO2: a new tool to minimize the risk of ischemia caused by hyperventilation therapy. Zentralbl Neurochir 1996;57:177–183.PubMedGoogle Scholar
  25. 25.
    Dings J, Meixensberger J, Roosen K. Brain tissue pO2-monitoring: catheter stability and complications. Neurol Res 1997;19:241–245.PubMedGoogle Scholar
  26. 26.
    Doppenberg EM, Zauner A, Bullockl R, et al. Correlations between brain tissue oxygen tension, carbon dioxide tension, pH, and cerebral blood flow-a better way of monitoring the severely injured brain? Surg Neurol 1998;49:650–654.PubMedCrossRefGoogle Scholar
  27. 27.
    Doppenberg EM, Zauner A, Watson JC, et al. Determination of the ischemic threshold for brain oxygen tension. Acta Neurochir Suppl (Wien) 1998;71:166–169.Google Scholar
  28. 28.
    Enblad P, Valtysson J, Andersson J, et al. Simultaneous intracerebral microdialysis and positron emission tomography in the detection of ischemia in patients with subarachnoid hemorrhage. J Cereb Blood Flow Metab 1996;16:637–644.PubMedCrossRefGoogle Scholar
  29. 29.
    Frykholm P, Hillered L, Langstrom B, et al. Increase of interstitial glycerol reflects the degree of ischemic brain damage: a PET and microdialysis study in a middle cerebral artery occlusion-reperfusion primate model. J Neurol Neurosurg Psychiatry 2001; 71:455–461.PubMedCrossRefGoogle Scholar
  30. 30.
    Ghajar JBH, RJ, et al. Improved outcome from traumatic coma using only ventricular cerebrospinal fluid drainage for intracranial pressure control. Adv Neurosurg 1993;21:173–177.Google Scholar
  31. 31.
    Giancoli DC Physics: principles with applications, 5th ed. Upper Saddle River. Prentice Hall, 1998.Google Scholar
  32. 32.
    Gibbs E, Lennox W, Nims L, et al. Arterial and cerebral venous blood: Arterial-venous differences in man. J Biol Chem 1942;144:325–332.Google Scholar
  33. 33.
    Goodman JC, Gopinath SP, Valadka AB, et al. Lactic acid and amino acid fluctuations measured using microdialysis reflect physiological derangements in head injury. Acta Neurochir Suppl (Wien) 1996;67:37–39.Google Scholar
  34. 34.
    Goodman JC, Valadka AB, Gopinath SP, et al. Extracellular lactate and glucose alterations in the brain after head injury measured by microdialysis. Crit Care Med 1999;27:1965–1973.PubMedCrossRefGoogle Scholar
  35. 35.
    Gopez JJM, RJ, Narayan RK. When and How Should I Monitor Intracranial Pressure In: Valadka ABaA, B.T. (ed): Nuerotrauma-Evidence-based Answers to Common Questions. New York Thieme, 2004;Vol. 1,53–61.Google Scholar
  36. 36.
    Gopinath SP, Robertson CS, Contant CF, et al. Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry 1994;57:717–723.PubMedGoogle Scholar
  37. 37.
    Gopinath SP, Valadka AB, Uzura M, et al. Comparison of jugular venous oxygen saturation and brain tissue Po2 as monitors of cerebral ischemia after head injury. Crit Care Med 1999;27:2337–2345.PubMedCrossRefGoogle Scholar
  38. 38.
    Gray BG, Ichise M, Chung DG, et al. Technetium-99m-HMPAO SPECT in the evaluation of patients with a remote history of traumatic brain injury: a comparison with x-ray computed tomography. J Nucl Med 1992;33:52–58.PubMedGoogle Scholar
  39. 39.
    Gupta AK, Hutchinson PJ, Al-Rawi P, et al. Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 1999;88:549–553.PubMedCrossRefGoogle Scholar
  40. 40.
    Haitsma IK, Mass AI. Advanced monitoring in the intensive care unit: brain tissue oxygen tension. Curr Opin Crit Care 2002;8:115–120.PubMedCrossRefGoogle Scholar
  41. 41.
    Hillered L, Persson L. Parabanic acid for monitoring of oxygen radical activity in the injured human brain. Neuroreport 1995;6:1816–1820.PubMedCrossRefGoogle Scholar
  42. 42.
    Hillered L, Valtysson J, Enblad P, et al. Interstitial glycerol as a marker for membrane phospholipid degradation in the acutely injured human brain. J Neurol Neurosurg Psychiatry 1998;64:486–491.PubMedGoogle Scholar
  43. 43.
    Hoeffner EG, Case I, Jain R, et al. Cerebral perfusion CT: technique and clincial applications. Radiology 2004;231:632–644.PubMedCrossRefGoogle Scholar
  44. 44.
    Hutchinson PJ, Gupta AK, Fryer TF, et al. 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 2002;22:735–745.PubMedCrossRefGoogle Scholar
  45. 45.
    Hutchinson PJ, O'Connell MT, Al-Rawi PG, et al. Clincial cerebral mcriodialysis: a methodological study. J Neurosurg 2000;93:37–43.PubMedGoogle Scholar
  46. 46.
    Imberti R, Bellinzona G, Langer M. Cerebral tissue Po2 and Sjvo2 changes during moderate hyperventilation in patients with severe traumatic brain injury. J Neurosurg 2002;96:97–102.PubMedGoogle Scholar
  47. 47.
    Jacobs A, Put E, Ingels M, et al. Prospective evaluation of technetium-99m-HMPAO SPECT in mild and moderate traumatic brain injury. J Nucl Med 1994;35:942–947.PubMedGoogle Scholar
  48. 48.
    Jaggi JL, Obrist WD, Gennarelli TA, et al. Relationship of early cerebral blood flow and metabolism to outcome in acute head injury. J Neurosurg 1970;72:176–182.Google Scholar
  49. 49.
    Jennett B, Bond M: Assesment of outcome after severe brain damage. Lancet 1975;1:480–484.PubMedCrossRefGoogle Scholar
  50. 50.
    Jennett B, Teasdale G, Braakman R, et al. Predicting outcome in individual patients after severe head injury. Lancet 1976;1:1031–1034.PubMedCrossRefGoogle Scholar
  51. 51.
    Jennett B, Teasdale G, Galbraith S, et al. Pognosis in patients with severe head injury. Acta Neurochir Suppl (Wien) 1979; 28:149–152.Google Scholar
  52. 52.
    Jennett B, Teasdale G, Gallbraith S, et al. Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 1977;40:291–298.PubMedGoogle Scholar
  53. 53.
    Jennett B, Teasdale G, Knill-Jones R. Prognosis after severe head injury. Ciba Found Symp 1975:309–324.Google Scholar
  54. 54.
    Johnston AJ, Gupta AK. Advanced monitoring in the neurology intensive care unit: microdialysis. Curr Opin Crit Care 2002;8:121–127.PubMedCrossRefGoogle Scholar
  55. 55.
    Jones PA, Andrews PJ, Midgley S, et al. Measuring the burden of secondary insults in head-injured patients during intensive care. J Neurosurg Anesthesiol 1994;6:4–14.PubMedGoogle Scholar
  56. 56.
    Joukhadar C, Derendorf H, Microdialysis Muller M. A novel tool for clinical studies of anti-infective agents. Eur J Clin Pharmacol 2001;57:211–219.PubMedCrossRefGoogle Scholar
  57. 57.
    Kandel ER, Schwartz JH, Jessell TM: Principles of neural science, 4th ed. New York: McGraw-Hill Health, Professions Division; 2000.Google Scholar
  58. 58.
    Kelly D, Doberstein C, Becker D. General principles of head injury management In: Naraaan RK, Wilberger JE, Povlishock JT. eds. Neurotrauma. New York: McGraw Hill Health Professions Division, 1996;71–101.Google Scholar
  59. 59.
    Kett-White R, Hutchinson PJ, al-Rawi PG, et al. Extracellular lactate/pyruvate and glutamate changes in patients during peroperative episodes of cerebral ischaemia. Acta Neurochir Suppl 2002;81:363–365.PubMedGoogle Scholar
  60. 60.
    Kett-White R, Hutchinson PJ, Czosnyka M, et al. Multi-modal monitoring of acute brain injury. Adv Tech Stand Neurosurg 2002;27:87–134.PubMedGoogle Scholar
  61. 61.
    Kety S, Schmidt C. The nitrous oxide method for the quantitative determination of cerebral blood flow in man. Theory, procedure, and normal values. J Clin Invest 1948;27:475–483.Google Scholar
  62. 62.
    Khurana V, Benarroch E, Kautsic Z, et al. Cerebral blood flow and metabolism In: Winn HR, Youmans JR, eds. Youmans neurological surgery 5the ed. Philadelphia: Saunders, 2004; Vol 2, 1467–1494.Google Scholar
  63. 63.
    Kiening KL, Hartl R, Unterberg AW, et al. Brain tissue pO2-monitoring in comatose patients: implications for therapy. Neurol Res 1997;19:233–240.PubMedGoogle Scholar
  64. 64.
    Kiening KL, Unterberg AW, Bardt TF, et al. Monitoring of crebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation,. J Neurosurg 1996;85:751–757.PubMedGoogle Scholar
  65. 65.
    Kinuya K, Kakuda K, Nobata K, et al. Role of brain perfusion single-photon emission tomography in traumatic head injury. Nucl Med Commun 2004;25:333–337.PubMedCrossRefGoogle Scholar
  66. 66.
    Koura SS, Doppenberg EM, Marmarou A, et al. Relationship between excitatory amino acid release and outcome after severe human head injury. Acta Neurochir Suppl (Wien) 1998;71:244–246.Google Scholar
  67. 67.
    Landolt H, Langemann H, Alessandri B: A concept for the introduction of cerebral microdialysis in neurointensive care. Acta Neurochir Suppl (Wien) 1996;67:31–36.Google Scholar
  68. 68.
    Landolt H, Langemann H, Mendelowitsch A, et al. Neurochemical monitoring and on-line pH measurements using brain mcriodialysis in patients in intensive care. Acta Neurochir Suppl (Wien) 1994;60:475–478.Google Scholar
  69. 69.
    Lundberg N, Troupp H, Lorin H. Continuous recording of the ventricular-fluid pressure, in patients with severe acute traumatic brain injury. A preliminary report. J Neurosurg 1965;22:581–592.PubMedGoogle Scholar
  70. 70.
    Macmillan CS, Andrews PJ. Cerebrovenous oxygen saturation monitoring: practicalconsiderations and clinical relevance. Intensive Care Med 2000;26:1028–1036.PubMedCrossRefGoogle Scholar
  71. 71.
    Manley GT, Hemphill JC, Morabito D, et al. Cerebral oxygenation during hemorrhagic shock: perils of hyperventilation and the therapeutic potential of hypoventilation. J Trauma 2000;48:1025–1032; discussion 1032–1033.PubMedGoogle Scholar
  72. 72.
    Manley GT, Pitts LH, Morabito D, et al. Brain tissue oxygenation during hemorrhagic shock, resuscitation, and alterations in ventilation. J Trauma 1999;46:261–267.PubMedGoogle Scholar
  73. 73.
    Marklund N, Ostman B, Nalmo L, et al. Hypoxanthine, uric acid and allantoin as indicators of in vivo free radical reactions. Description of a HPLC method and human brain microdialysis data. Acta Neurochir (Wien) 2000;142:1135–1141; discussion 1141–1142.CrossRefGoogle Scholar
  74. 74.
    Marmarou A, Anderson R, Ward J, et al. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991;75:S59-S66.Google Scholar
  75. 75.
    Marshall L, Marshall S, Grady M: Modern neurotraumatology: A brief historical review In: Winn HR, Youmans JR, eds. Youmans neurological surgery, 5th ed. Philadelphia: Saunders, 2004;vol 4, 5019–5024.Google Scholar
  76. 76.
    Marshall LF, Becker DP, Bowers SA, et al. The National Traumatic Coma Data Bank. Part 1: Design, purpose, goals, and results. J Neurosurg 1983;59:276–284.PubMedGoogle Scholar
  77. 77.
    Meixensberger J, Jager A, Dings J, et al. Multimodal hemodynamic neuromonitoring-quality and consequences for therapy of severely head injured patients. Acta Neurochir Suppl (Wien) 1998;71:260–262.Google Scholar
  78. 78.
    Meixensberger J, Kunze E, Barcsay E, et al. Clinical cerebral microdialysis: brain metabolism and brain tissue oxygenation after acute brain injury. Neurol Res 2001;23:801–806.PubMedCrossRefGoogle Scholar
  79. 79.
    Mendelowitsch A, Langemann H, Alessandri B, et al. Microdialytic monitoring of the cortex during neurovascular surgery. Acta Neurochir Suppl (Wien) 1996;67:48–52.Google Scholar
  80. 80.
    Miller J, Piper I, Jones P: Pathophysiology of head injury. In: Narayan RK, Wilberger JE, Povlishock JT, eds. Neurotrauma New York: McGraw Hill Health Professions Division, 1996:61–69.Google Scholar
  81. 81.
    Muller M. Science, medicine, and the future. Microdialysis. Bmj 2002;324:588–591.CrossRefGoogle Scholar
  82. 82.
    Narayan RK, Kishore PR, Becker DP, et al. Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 1982;56:650–659.PubMedGoogle Scholar
  83. 83.
    Newberg AB, Alavi A. Neuroimaging in patients with head injury. Semin Nucl Med 2003;33:136–147.PubMedCrossRefGoogle Scholar
  84. 84.
    North B, Reilly P. Comparison among three methods of intracranial pressure recording. Neurosurgery 1986;18:730–732.PubMedCrossRefGoogle Scholar
  85. 85.
    Ostrup RC, Luerssen TG, Marshall LF, et al. Continuous monitoring of intracranial pressure with a miniaturized fiberoptic device. J Neurosurg 1987;67:206–209.PubMedGoogle Scholar
  86. 86.
    Owen-Reece H, Smith M, Elwell CE, et al. Near infrared spectroscopy. Br J Anaesth 1999;82:418–426.PubMedGoogle Scholar
  87. 87.
    Peedeman SM, Girbes AR, Vandertop WP. Cerebral microdialysis as a new tool for neurometabolic monitoring. Intensive Care Med 2000;26:662–669.CrossRefGoogle Scholar
  88. 88.
    Peerdeman SM, van Tulder MW, Vandertop WP. Cerebral microdialysis as a monitoring method in subarachnoid hemorrhage patients, and correlation with clinical events-a systematic review. J Neurol 2003;250:797–805.PubMedCrossRefGoogle Scholar
  89. 89.
    Persson L, Valtysson J, Enblad P, et al. Neurochemical monitoring using intracerebral microdialysis in patients withsubarachnoid hemorrhage. J Neurosurg 1996;84:606–616.PubMedCrossRefGoogle Scholar
  90. 90.
    Piek J, Bock WJ. Continuous monitoring of cerebral tissue pressure in neurosurgical paractice-experiences with 100 patiens. Intensive Care Med 1990;16:184–188.PubMedCrossRefGoogle Scholar
  91. 91.
    Robertson C. Critical care management of traumatic brain injury In: Winn HR, Youmans JR, eds. Youmans neurological surgery, 5th ed. Philadelphia: Saunders, 2004:Vol 4,5103–5144.Google Scholar
  92. 92.
    Robertson CS, Gopinath SP, Goodman JC, et al. SjvO2 monitoring in head-injured patients. J Neurotrauma 1995;12:891–896.PubMedGoogle Scholar
  93. 93.
    Roper SN, Mena I, King WA, et al. An analysis of cerebral blood flow in acuteclosed-head injury using technetium-99m-HMPAO SPECT and computed tomography. J Nucl Med 1991;32:1684–1687.PubMedGoogle Scholar
  94. 94.
    Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 1995; 83:949–962.PubMedGoogle Scholar
  95. 95.
    Ruff RM, Marshall LF, Crouch J, et al. Predictors of outcome following severe head trauma: follow-up data from the Traumatic Coma Data Bank. Brain Inj 1993;7:101–111.PubMedCrossRefGoogle Scholar
  96. 96.
    Sarrafzadeh A, Haux D, Sakowitz O, et al. Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside mcriodialysis. Stroke 2003;34:1382–1388.PubMedCrossRefGoogle Scholar
  97. 97.
    Sarrafzadeh AS, Kiening KL, Bardt TF, et al. Cerebral oxygenation in contusioned vs nonlesioned brain tissue: monitoring of PtiO2 withLicox and Paratrend. Acta Neurochir Suppl (Wien) 1998;71:186–189.Google Scholar
  98. 98.
    Sarrafzadeh AS, Kiening KI, Callsen TA, et al. Metabolic changes during impending and manifest cerebral hypoxia in traumatic brain injury. Br J Neurosurg 2003;17:340–346.PubMedCrossRefGoogle Scholar
  99. 99.
    Sarrafzadeh AS, Kiening KL, Unterberg AW. Neuromonitoring: brain oxygenation and microdialysis. Curr Neurol Neurosci Rep 2003;3:517–523.PubMedCrossRefGoogle Scholar
  100. 100.
    Sarrafzadeh AS, Sakowitz OW, Kiening KL, et al. Bedside mcriodialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients. Crit Care Med 2002;30:1062–1070.PubMedCrossRefGoogle Scholar
  101. 101.
    Shiina G, Onuma T, Kameyama M, et al. Sequential assessment of crebral blood flow in diffuse brain injury by 123I-iodoamphetamine single-photon emission CT. AJNR Am J Neuroradiol 1998;19:297–302.PubMedGoogle Scholar
  102. 102.
    Siesjo BK. Pathophysiology and treatment of focal cerebral ischemia. Part I: Pathophysiology. J Neurosurg 1992;77:169–184.PubMedGoogle Scholar
  103. 103.
    Siesjo BK. Pathophysiology and treatment of focal cerebral ischemia. Part II: Mechanisms of damage and treatment. J Neurosurg 1992;77:337–354.PubMedGoogle Scholar
  104. 104.
    Siesjö P, Siesjö B. Cerebral metabolism and the pathophysiology of ischemic brain damage In: Winn HR, Youmans JR, eds. Youmans neurological surgery, 5th ed. Philadelphia: Saunders, 2004;Vol. 1. 117–152.Google Scholar
  105. 105.
    Smythe PR, Samra SK. Monitors of crebral oxygenation. Anesthesiol Clin North America 2002;20:293–313.PubMedCrossRefGoogle Scholar
  106. 106.
    Sorensen AG, Riemer P, Cerebral MR Perfusion Imaging: Principles and Current Applications. New York: Thieme Verlag, 2000.Google Scholar
  107. 107.
    Strangman G, O'Neil-Pirozzi TM, Burke D, et al. Functional neuroimaging and cognitive rehabilitation for people with traumatic brain injury. Am J Phys Med Rehabil 2005;84:62–75.PubMedCrossRefGoogle Scholar
  108. 108.
    Rim SJ, Poi HW, Lindner J, et al. Quantification of Cerebral Perfusion With Real Time Contrast Enhanced Ultrasonography. Circulation 2001;104(21):2582–2587.PubMedCrossRefGoogle Scholar
  109. 109.
    Townsend DW. Physical principles and technology of clinical PET imaging. Ann Acad Med Singapore 2004;33:133–145.PubMedGoogle Scholar
  110. 110.
    Turner MS. ThinkFirst: fundamentals of injury prevention. Clin Neurosurg 2004;51:39–42.PubMedGoogle Scholar
  111. 111.
    Unterberg AW, Kiening KL, Hartl R, et al. Multimodal monitoring in patients with head injury: evaluation of the effects of treatment on cerebral oxygenation. J Trauma 1997;42:S32–37.Google Scholar
  112. 112.
    Valadka AB, Goodman JC, Gopinath SP, et al. Comparison of brain tissue oxygen tension to microdialysis-based measures of cerebral ischemia in fatally head-injured humans. J Neurotrauma 1998;15:509–519.PubMedGoogle Scholar
  113. 113.
    Valadka AB, Gopinath SP, Contant CF, et al. Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med 1998;26:1576–1581.PubMedCrossRefGoogle Scholar
  114. 114.
    van den Brink WA, van Santbrink H, Steyerberg EW, et al. Brain oxygen tension in severe head injury. Neurosurgery 2000;46:868–876; discussion 876–878.PubMedCrossRefGoogle Scholar
  115. 115.
    van Santbrink H, Maas AI, Avezaat CJ. Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 1996;38:21–31.PubMedCrossRefGoogle Scholar
  116. 116.
    West JB. Respiratory physiology: the essentials, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2000.Google Scholar
  117. 117.
    Wintermark M, Chiolero R, van Melle G, et al. Relationship between brain perfusion computed tomography variables and cerebral perfusion pressure in severe head trauma patients. Crit Care Med 2004;32:1579–1587.PubMedCrossRefGoogle Scholar
  118. 118.
    Yonas H, Pindzola RP, Johnson DW. Xenon/computed tomography cerebral blood flow and its use in clinical management. Neurosurg Clin N Am 1996;7:605–616.PubMedGoogle Scholar
  119. 119.
    Zauner A, Daugherty WP, Bullock MR, et al. Brain oxygenation and energy metabolism: part I-biological function and pathophysiology. Neurosurgery 2002;51:289–301; discussion 302.PubMedCrossRefGoogle Scholar
  120. 120.
    Zauner A, Doppenberg E, Woodward JJ, et al. Multiparametric continuous monitoring of brain metabolism and substrate delivery in neurosurgical patients. Neurol Res 1997;19:265–273.PubMedGoogle Scholar
  121. 121.
    Zauner A, Doppenberg EM, Woodward JJ, et al. Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 1997;41:1082–1091; discussion 1091–1093.PubMedCrossRefGoogle Scholar
  122. 122.
    Cruz J. An additional therapeutic effect of adequate hyperventilation in severe acute brain trauma: normalization of cerebral glucose uptake. J Neurosurg 1995;82:379–385.PubMedGoogle Scholar
  123. 123.
    Vajkoczy P, Roth H, Horn P, et al. Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe. J Neurosurg 2000;93:265–274.PubMedCrossRefGoogle Scholar
  124. 124.
    Jaeger M, Soehle M, Schuhmann MU, Winkler D, Meixensberger I. Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen. Acta Neurochir (Wien) 2005;147:51–56.CrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2006

Authors and Affiliations

  • Brigham and Women's Hospital Neurosurgery Group
    • 1
  1. 1.Department of NeurosurgeryBrigham and Women's Hospital, Harvard Medical SchoolBoston

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