Persistence of papilloedema after operation for intracranial tumour

The resolution of papilloedema after removal of an intracranial tumour in 14 patients (group 1) was compared with that after a CSF shunt operation in 12 patients (group 2). In group 1, the longest time needed for resolution was 20 weeks; there was no consistent relation between severity of papilloedema and time of resolution, and in 4 patients papilloedema subsided only after more than 10 weeks. In group 2, the longest time needed for resolution was 6 weeks and the time of resolution was closely related to the severity of papilloedema. Persistence of papilloedema after removal of an intracranial tumour may be explained by raised CSF pressure caused by a postoperative CSF circulation block which occurs in some patients. If vision is threatened in such cases, a CSF shunt operation should be performed.     

Brain and intracranial cavity volumes: in vivo determination by MRI

Brain volume is altered by pathological processes such as swelling or atrophy yet until now this is a parameter which could only be determined at post mortem. This paper describes a non-invasive technique using MRI which permits the in vivo determination of brain volume (BV), intracranial cavity volume (ICV), ventricular, cortical sulcal and total intracranial CSF volumes. The technique was applied to 40 normal volunteers (20 males, 20 females) to investigate the variation of these parameters with age and sex after normalisation with respect to ICV. There was found to be a significant decrease in normalised brain volume between the ages of 20 and 60 years in males by 1.6% per decade. In females the decrease was less (0.5%) but was not statistically significant. This technique will make it possible, for the first time, to investigate prospectively the correlation between mental function and brain volume in illness and ageing.     

颅内压监护在急性中型颅脑损伤患者治疗中的意义

目的研究原发性急性中型颅脑损伤患者行颅内压(ICP)监测对临床诊治的意义。方法71例伤后24h内入院的原发性急性中型颅脑损伤患者,入院时均行头部CT检查无手术指征,将其随机分为ICP监护治疗组(35例):入院后即采用目前国际上通用的脑室内穿刺置管法行ICP持续监护,用美国产Marquette监护仪进行4 ~ 7 d连续监测;常规治疗组(36例):进行包括脱水、止血、防治上消化道出血等治疗,监测生命征、意识的改变及血、尿等常规和生化指标,必要时对治疗方案作出调整。结果ICP监护治疗组出现3例ICP>40 mmHg或入院后ICP很快进行性增高,行CT检查发现迟发性颅内血肿或原位血肿增大、中线明显移位,即手术治疗。术后1例重残,1例中残,1例轻残;另有5例患者ICP监护中发现达中度增高(20 ~ 40 mmHg),CT检查提示仅为脑水肿加重,不具手术指征,经调整脱水药剂量,间断开放脑室外引流后病情平稳好转。结论中型颅脑损伤伤后病情不稳定,行ICP监测能及早发现病情变化,可降低致残率和死亡率,有效提高疗效,改善预后。     

Non-invasive assessment of cerebrospinal fluid flow dynamics using phase-contrast magnetic resonance imaging in communicating hydrocephalus

This work aims to evaluate the changes in cerebrospinal fluid (CSF) hydrodynamics in patients diagnosed with communicating hydrocephalus. Besides, we establish the relationship between CSF flow dynamic parameters on the midbrain aqueduct and intracranial pressure (ICP). CSF hydrodynamics analysis was performed using Phase-Contrast Magnetic Resonance Imaging (PC‐MRI) techniques on the midbrain aqueduct of 41 patients diagnosed with communicating hydrocephalus and 22 healthy volunteers. The correlation between CSF average flow in the midbrain aqueduct and intracranial pressure measured by Lumbar Puncture (LP) was assessed in patients with hydrocephalus. Pearson correlation coefficient was used to establish the correction between the average CSF flow of midbrain aqueduct and ICP. CSF dynamic parameters of the midbrain aqueduct in hydrocephalus patients, including peak positive velocity (7.348 cm/s), average velocity (0.623 cm/s), average flow (50.799 mm³/s), and regions of interest (ROI) area (9.978 mm²) were significantly higher than in the healthy controls (p < 0.05). This was after adjusting the age, gender, heart rate, systolic blood pressure, diastolic blood pressure, and body mass index. However, only the peak negative velocity of the midbrain aqueduct did not significantly differ between the groups (p = 0.209). A positive correlation was noted between the average flow (AF) of the midbrain aqueducts and ICP in hydrocephalus patients (y (AF) = 0.386× (ICP)−33.738, r = 0.787, p < 0.05). Reference data of CSF flow dynamic parameters was obtained through the PC-MRI in middle-aged healthy volunteers and communicating hydrocephalus patients. Although the sample size was constrained, this study has significant contributions. For instance, a significant correlation was noted between the average CSF flow of the aqueduct and ICP. This therefore provides a reference for clinicians to monitor ICP in patients with hydrocephalus.     

Non-invasive measurement in intracranial pressure and analysis of the pulse waveform

Non-invasive measurement of the intracranial pressure (ICP) via the anterior fontanelle by using an applanation transducer has been performed. Recently, a new fontanometer using an applanation transducer has been developed in our department by improving the conventional Statham tranducer, P-50 which is currently accepted for its high reliability. In this study, by analysing patterns of the ICP pulse waves obtained from this new fontanometer, its clinical evaluation has been made in 27 neonates and infants in intracranial pathologies. Analysing the ICP waveforms, the first peak (P₁) was divided by the following second peak (P₂) and the changes in P₁/P₂ were examined. A differential amplifier, a dP/dt detector, was also used to make it easier to identify the turning point on the pulse waves.

The results obtained demonstrated that the waveforms of ICP in neonates as well as infants are influenced by not only the intracranial constituents but compliance of the container such as the scalp, cranium and the meninges.     

Chronic intracranial hypotension

Acute intracranial hypotension can occur following lumbar puncture or a fall, and sometimes spontaneously. Most cases resolve within weeks or months but some require surgical repair of the defect causing leakage of cerebrospinal fluid (CSF). It is conceivable that such leaks could become chronic if the defect is incompletely sealed. We report the case of a 49-year-old male who presented with a 10-month history of headache associated with a leaking thoracic extradural arachnoid cyst. After this was repaired he reported relief not only of his recent headaches but also of chronic alcohol-related headaches. A long-standing anaemia resolved and tinnitus hyperacusis improved. It is suggested that an injury 30 years before may have initiated the leak of CSF resulting in chronic intracranial hypotension.     

Effect of amiloride and emopamil on intracranial pressure

The authors sought to determine whether amiloride or emopamil could reduce intracranial pressure in experimental brain edema of the rat. For this purpose the rats were functionally nephrectomized and brain edema of the cytotoxic type induced by infusion of 100 ml aqua bidest/kg body weight. After the end of the infusion 10 or 20 ml 2 mM amiloride/kg body weight or 50 μ1 1 mM (s)-emopamil/kg body weight in 10 ml 150 mM NaCl /kg body weight or 10 ml isotonic saline/kg body weight were injected followed by continued recording of intracranial pressure (ICP) and systemic arterial pressure for at least 3 hours. The values of the ICP for the amiloride and s-emopamil treated animals are significantly p < 0.05, Student's t-test for unpaired data) lower at any point after the injection of amiloride or (s)-emopamil. Amiloride and (s)-emopamil prevent the rise in ICP seen after the saline injection in the control group.     

Noninvasive assessment of the intracranial pressure in non-traumatic intracranial hemorrhage

The article describes the modified technique of measuring the diameters of the optic nerve sheath (ONSD) for assessment of the intracranial pressure (ICP) in patients with intracerebral or subarachnoid hemorrhage (SAH). The CT scans of 443 patients were analyzed retrospectively. The ONSDs were measured at 3 mm behind the globe and at the point where the ophthalmic artery crosses the optic nerve. The ONSD/eyeball transverse diameter (ETD) ratio was calculated. The correlation analysis was performed with the Glasgow Coma Scale score, Hemispheric Stroke Scale score, Glasgow Outcome Score, and invasive ICP readings. ONSD was enlarged in 95% of patients with intracerebral hemorrhage or SAH. Pathological ONSDs were 6.6 ± 0.8 mm (cut-off value >5.5 mm; p < 0.05). ONSD/ETD ratio was 0.29 ± 0.05 against normative 0.19 ± 0.02 (p < 0.01) with no correlation with initial Glasgow Coma Scale score or Hemispheric Stroke Scale score. There was an inverse correlation between ONSD/ETD ratio and Glasgow Outcome Score (r = −0.7) and direct correlation with invasive ICP readings. This study provides further evidence that in patients with intracranial hemorrhage and SAH, the presence of ONSD greater than a threshold of 5.5 mm is significantly predictive of invasively measured elevated ICP. The prediction of raised ICP can be further refined by measuring ONSD at the point where the optic nerve and the ophthalmic artery cross, and by determining the ratio between the ONSD and ETD.     

连续动态颅内压监测在脑出血治疗中的应用评价

目的研究连续动态颅内压监测在脑出血治疗中的应用价值。方法选择我院神经外科2012年2月至2013年2月收治的72例高血压脑出血患者,行头颅CT检查确诊,出血量在30~50 ml之间。单纯基底节部出血42例,随机分为监测组与对照组,每组21例。基底节部出血并破入脑室者30例,随机分为监测组与对照组,每组15例。监测组连续监测颅内压3~7 d;对照组采用传统方法评价颅内压。当发现有颅内压升高的情况两组均采取及时降压的措施。对比患者出入院前后格拉斯哥评分(GCS)以及平均住院时间。结果对于单纯基底节部出血患者,出院时颅内压监测组GCS评分高于对照组(P0.05),颅内压监测组住院时间少于对照组(P0.05)。对于基底节部出血并破入脑室患者,出院时GCS评分监测组与对照组比较无统计学差异(P0.05);两组住院时间比较亦无统计学差异(P0.05)。结论连续动态颅内压监测在高血压脑出血治疗中可早期发现颅内压变化,进而指导采取相应合理的治疗措施,最终可以改善患者预后,降低死残率,具有很高的临床应用价值。     

Natural course of intracranial pressure and drainage of CSF after recovery from subarachnoid hemorrhage

Twenty-eight patients were followed 12 months or longer after recovery from subarachnoid hemorrhage (SAH). The examination included spinal infusion test (SIT), clinical evaluation and cerebral computertomography (CT). The results indicate that when resting pressure and drainage of CSF are within normal limits 3 months after the hemorrhage there is little if any risk of developing late communicating hydrocephalus. In this study, most patients with a moderate impaired CSF drainage and/or slightly increased resting pressure 3 months after SAH did not show any increase in the ventricular size or clinical deterioration during the follow-up period. None of the 28 patients developed late communicating hydrocephalus or the clinical picture of normal pressure hydrocephalus.     

Brain elastic behavior in experimental brain compression: Influence of steroid therapy

This paper describes the pathways for lithium transport across the axonal membrane of squid. We were able to show that the membrane of this classical neuronal preparation possesses the lithium transport mechanisms previously identified in red blood cells. It is now possible to predict that the lithium treatment-induced changes in choline and lithium transport that have been observed in red blood cells of manic depressive patients also occur in nerve membrane.     

蛛网膜下腔出血患者无创颅内压监测与脑功能状态相关性及其应用研究

目的 研究蛛网膜下腔出血(SAH)患者早期有创颅内压监测(腰椎穿刺测压或脑室外引流测压)与无创颅内压监测[闪光视觉诱发电位(F-VEP)监测]的差异性和适用性,并探讨颅内压、GCS评分与脑状态监测仪获取的数字化脑电信号[脑状态指数(CSI)、肌电指数(EMG)]之间的相关性. 方法 对深圳市人民医院神经外科自2011年3月至2011年12月收治的33例GCS评分3～12分SAH患者早期行腰椎穿刺测压或脑室外引流测压,同步进行F-VEP无创颅内压监测及脑功能状态监测,分析无创与有创颅内压监测值是否存在差异以及上述指标间的相关性. 结果 (1)患者有创颅内压监测(腰椎穿刺测压/脑室外引流测压)与无创监测结果比较差异均无统计学意义(t=-0.069,P=.946;t=-0.158,P=0.876).(2)患者颅内压与CSI呈负相关关系(r=-0.898,P=0.000),与EMG呈正相关关系(r=0.938,P=0.000); GCS评分与CSI存在正相关关系(r=0.472,P=0.011),与颅内压暂未发现相关关系(r=-0.047,P=0.814),与EMG不存在相关关系(r=-0.170,P=0.388).控制颅内压、GCS评分因素后偏相关分析发现CSI和EMG无相关关系(r=0.288,P=0.138). 结论 (1)SAH患者F-VEP监测颅内压与腰椎穿刺测压法或脑室外引流测压法监测具有相似效用.(2)CSI和EMG与颅内压具有良好相关性,表明病情变化与颅内压动态变化趋势相一致.     

颅内压监测在重型颅脑损伤中的应用

目的探讨颅内压(ICP)监测在重型颅脑损伤中的作用及意义。方法应用颅内压监护仪对42例重型颅脑损伤患者进行颅内压监测,对颅内压的变化与临床特征进行比较分析。结果 ICP 5~15 mmHg 5例,16~20 mmHg 14例,21~40 mmHg 17例,40 mmHg 6例。ICP初值与患者病死率有关,且呈负相关,差异具有统计学意义。结论重型颅脑损伤患者进行ICP监测对及早判断病情、治疗方面有重要价值。     

颅脑创伤患者的颅内压相关参数对预后的影响

目的探究颅内压相关参数对颅脑创伤（TBI）患者生存状况的影响。 方法回顾性分析新兴县人民医院神经外科自2016年6月至2018年6月收治的62例TBI患者的临床资料,依据出院时患者预后的GOS评分将其分为预后不良组（死亡、GOSⅠ~Ⅱ级,25例）与预后良好组（GOSⅢ~Ⅳ级,37例）。比较2组患者术后24 h内颅内压、脑组织氧分压、脑灌注压和血流动力学情况,并分析颅内压相关参数与TBI患者不良预后的相关性。 结果预后良好组患者的颅内压、脑组织氧分压水平低于预后不良组,脑灌注压、收缩期血流速度（Vs）、平均血流速度（Vm）和舒张期末血流速度（Vd）水平均高于预后不良组,差异均具有统计学意义（P<0.05）。TBI患者的颅内压、脑组织氧分压水平与不良预后呈现正相关（r=0.618,P=0.000;r=0.514,P=0.000）,脑灌注压水平、Vs、Vm和Vd与不良预后呈负相关（r=-0.571,P=0.000;r=-0.562,P=0.000;r=-0.501,P=0.000;r=-0.575,P=0.000）。 结论颅内压、脑组织氧分压、脑灌注压和血流动力学情况与TBI患者的预后具有相关性,积极控制颅内压和脑组织氧分压升高,促进脑灌注压,密切监测血流动力血指标,可改善患者生存状况。     

实时动态颅压监测对小剂量甘露醇脱水效果的评估

目的探究小剂量与常规制量甘露醇颅压降幅的差异及肾功受损的发生率。方法采用蛛网膜下腔置管的方法，实时动态监测小剂量和常规剂量甘露醇分别在颅压轻度增高组和显著增高组不同时段的颅压降幅。结果在颅压轻度升高组，小剂量与常规剂量的颅压降幅差异无显著性（P〉0．05）；存颅压显著升高组，二者的颅压降幅差异具有显著性（P〈0．05）；肾功损害的发生率，二者差异无显著性（P〈0．05）。结论甘露醇剂量的选择应视颅压增高的程度而定，对颅压显著增高的病人宜选用常规剂量。     

Effect of torasemide on intracranial pressure, mean systemic arterial pressure and cerebral perfusion pressure in experimental brain edema of the rat

The study was performed to establish whether a lipophilic loop diuretic, torasemide could modify intracranial pressure and cytotoxic brain edema. Brain edema was induced by water intoxication in nephrectomized rats. Following intravenous injection of 100 mg torasemide/kg body weight at 50, 60, 70, 90 and 120 min, a significant decrease of intracranial pressure was observed.     

脑脊液铜、锌水平与颅内肿瘤的关系

目的：探讨脑脊液（ＣＳＦ）铜、锌浓度与颅内肿瘤的关系。方法：对５１例颅内肿瘤患者和２２例健康体检者的ＧＳＦ进行铜、锌浓度和蛋白的检测。结果：与对照组相比,颅内肿瘤患者ＣＳＦ铜显著升高（Ｐ＜０．０５）,其异常率为４７．０％。锌无显著性变化（Ｐ＞ ０．０５）,铜／锌比值有极显著性升高（Ｐ＜ ０．０１）,其异常率为６２．７％远大于蛋白的异常率３５．３％。结论：脑脊液铜与颅内肿瘤的关系较为密切,在一定程度上反映了该类疾病与铜参与的免疫和代谢有关。对于颅内肿瘤的诊断,铜／锌比值较铜和蛋白更具有价值。     

颅内压监测临床研究现状及相关参数进展

颅内压（ICP）监测的意义已经得到公认，但临床应用中仍存在许多问题。在大数据时代的影响下，ICP监测从简单测压衍生出与其相关的参数，并从孤立数值转变为ICP与脑生理代谢、神经功能的多模态监测研究，利用计算机实时数据处理得出最优灌注压，为及时调整治疗方案、保持良好脑灌注及脑代谢提供可靠依据，精准治疗神经外科疾病。本文现围绕ICP监测现状及相关参数研究展开综述。