Intracerebral microdialysis in severe brain trauma: The importance of catheter location

Martin Engström, Angelo Polito, Peter Reinstrup, Bertil Romner, Erik Ryding, Urban Ungerstedt, Carl Henrik Nordström

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Object. Intracerebral microdialysis has attracted increasing interest as a monitoring technique during neurological/neurosurgical intensive care. The purpose of this study was to compare cerebral energy metabolism, an indicator of secondary excitotoxic injury and cell membrane degradation close to focal traumatic lesions ("penumbra zones") and in remote and apparently intact brain regions of the ipsilateral and contralateral hemispheres. Methods. The study included 22 consecutive patients with a mean age 44 ± 17 years and an estimated postresuscitation Glasgow Coma Scale motor score less than 5. Altogether 40 microdialysis catheters with radiopaque tips were inserted. Two catheters could not be localized on postoperative computerized tomography (CT) scans and were excluded from the analysis. The perfusates were analyzed at the patient's bedside for levels of glucose, pyruvate, lactate, glutamate, and glycerol with the aid of a CMA 600 Analyzer. The positions of eight (22%) of the 36 catheters were reclassified after a review of findings on CT scans. Except for pyruvate the values of all biochemical variables and the lactate/pyruvate (L/P) ratio were significantly different in the penumbra zone when compared with mean values found in "normal" tissue ipsilateral to the parenchymal damage and in contralateral normal tissue (p <0.001). In the penumbra zone a slow normalization of the L/P ratio and levels of glutamate and glycerol were observed. In normal tissue these parameters remained within normal limits. Conclusions. Data obtained from intracerebral microdialysis can be correctly interpreted only if the locations of the catheters as they relate to focal brain lesions are visualized. A "biochemical penumbra zone" surrounds focal traumatic brain lesions. It remains to be proven whether therapeutic interventions can protect the penumbra zone from permanent damage.

Original languageEnglish
Pages (from-to)460-469
Number of pages10
JournalJournal of Neurosurgery
Volume102
Issue number3
DOIs
Publication statusPublished - Mar 2005

Fingerprint

Microdialysis
Pyruvic Acid
Catheters
Lactic Acid
Glycerol
Glutamic Acid
Brain
Tomography
Glasgow Coma Scale
Critical Care
Energy Metabolism
Cell Membrane
Glucose
Traumatic Brain Injury
Wounds and Injuries
Therapeutics

Keywords

  • Brain trauma
  • Microdialysis
  • Penumbra zone

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Engström, M., Polito, A., Reinstrup, P., Romner, B., Ryding, E., Ungerstedt, U., & Nordström, C. H. (2005). Intracerebral microdialysis in severe brain trauma: The importance of catheter location. Journal of Neurosurgery, 102(3), 460-469. https://doi.org/10.3171/jns.2005.102.3.0460

Intracerebral microdialysis in severe brain trauma : The importance of catheter location. / Engström, Martin; Polito, Angelo; Reinstrup, Peter; Romner, Bertil; Ryding, Erik; Ungerstedt, Urban; Nordström, Carl Henrik.

In: Journal of Neurosurgery, Vol. 102, No. 3, 03.2005, p. 460-469.

Research output: Contribution to journalArticle

Engström, M, Polito, A, Reinstrup, P, Romner, B, Ryding, E, Ungerstedt, U & Nordström, CH 2005, 'Intracerebral microdialysis in severe brain trauma: The importance of catheter location', Journal of Neurosurgery, vol. 102, no. 3, pp. 460-469. https://doi.org/10.3171/jns.2005.102.3.0460
Engström, Martin ; Polito, Angelo ; Reinstrup, Peter ; Romner, Bertil ; Ryding, Erik ; Ungerstedt, Urban ; Nordström, Carl Henrik. / Intracerebral microdialysis in severe brain trauma : The importance of catheter location. In: Journal of Neurosurgery. 2005 ; Vol. 102, No. 3. pp. 460-469.
@article{ba49b7746b3a4fec9cb003ca5466d0ce,
title = "Intracerebral microdialysis in severe brain trauma: The importance of catheter location",
abstract = "Object. Intracerebral microdialysis has attracted increasing interest as a monitoring technique during neurological/neurosurgical intensive care. The purpose of this study was to compare cerebral energy metabolism, an indicator of secondary excitotoxic injury and cell membrane degradation close to focal traumatic lesions ({"}penumbra zones{"}) and in remote and apparently intact brain regions of the ipsilateral and contralateral hemispheres. Methods. The study included 22 consecutive patients with a mean age 44 ± 17 years and an estimated postresuscitation Glasgow Coma Scale motor score less than 5. Altogether 40 microdialysis catheters with radiopaque tips were inserted. Two catheters could not be localized on postoperative computerized tomography (CT) scans and were excluded from the analysis. The perfusates were analyzed at the patient's bedside for levels of glucose, pyruvate, lactate, glutamate, and glycerol with the aid of a CMA 600 Analyzer. The positions of eight (22{\%}) of the 36 catheters were reclassified after a review of findings on CT scans. Except for pyruvate the values of all biochemical variables and the lactate/pyruvate (L/P) ratio were significantly different in the penumbra zone when compared with mean values found in {"}normal{"} tissue ipsilateral to the parenchymal damage and in contralateral normal tissue (p <0.001). In the penumbra zone a slow normalization of the L/P ratio and levels of glutamate and glycerol were observed. In normal tissue these parameters remained within normal limits. Conclusions. Data obtained from intracerebral microdialysis can be correctly interpreted only if the locations of the catheters as they relate to focal brain lesions are visualized. A {"}biochemical penumbra zone{"} surrounds focal traumatic brain lesions. It remains to be proven whether therapeutic interventions can protect the penumbra zone from permanent damage.",
keywords = "Brain trauma, Microdialysis, Penumbra zone",
author = "Martin Engstr{\"o}m and Angelo Polito and Peter Reinstrup and Bertil Romner and Erik Ryding and Urban Ungerstedt and Nordstr{\"o}m, {Carl Henrik}",
year = "2005",
month = "3",
doi = "10.3171/jns.2005.102.3.0460",
language = "English",
volume = "102",
pages = "460--469",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "3",

}

TY - JOUR

T1 - Intracerebral microdialysis in severe brain trauma

T2 - The importance of catheter location

AU - Engström, Martin

AU - Polito, Angelo

AU - Reinstrup, Peter

AU - Romner, Bertil

AU - Ryding, Erik

AU - Ungerstedt, Urban

AU - Nordström, Carl Henrik

PY - 2005/3

Y1 - 2005/3

N2 - Object. Intracerebral microdialysis has attracted increasing interest as a monitoring technique during neurological/neurosurgical intensive care. The purpose of this study was to compare cerebral energy metabolism, an indicator of secondary excitotoxic injury and cell membrane degradation close to focal traumatic lesions ("penumbra zones") and in remote and apparently intact brain regions of the ipsilateral and contralateral hemispheres. Methods. The study included 22 consecutive patients with a mean age 44 ± 17 years and an estimated postresuscitation Glasgow Coma Scale motor score less than 5. Altogether 40 microdialysis catheters with radiopaque tips were inserted. Two catheters could not be localized on postoperative computerized tomography (CT) scans and were excluded from the analysis. The perfusates were analyzed at the patient's bedside for levels of glucose, pyruvate, lactate, glutamate, and glycerol with the aid of a CMA 600 Analyzer. The positions of eight (22%) of the 36 catheters were reclassified after a review of findings on CT scans. Except for pyruvate the values of all biochemical variables and the lactate/pyruvate (L/P) ratio were significantly different in the penumbra zone when compared with mean values found in "normal" tissue ipsilateral to the parenchymal damage and in contralateral normal tissue (p <0.001). In the penumbra zone a slow normalization of the L/P ratio and levels of glutamate and glycerol were observed. In normal tissue these parameters remained within normal limits. Conclusions. Data obtained from intracerebral microdialysis can be correctly interpreted only if the locations of the catheters as they relate to focal brain lesions are visualized. A "biochemical penumbra zone" surrounds focal traumatic brain lesions. It remains to be proven whether therapeutic interventions can protect the penumbra zone from permanent damage.

AB - Object. Intracerebral microdialysis has attracted increasing interest as a monitoring technique during neurological/neurosurgical intensive care. The purpose of this study was to compare cerebral energy metabolism, an indicator of secondary excitotoxic injury and cell membrane degradation close to focal traumatic lesions ("penumbra zones") and in remote and apparently intact brain regions of the ipsilateral and contralateral hemispheres. Methods. The study included 22 consecutive patients with a mean age 44 ± 17 years and an estimated postresuscitation Glasgow Coma Scale motor score less than 5. Altogether 40 microdialysis catheters with radiopaque tips were inserted. Two catheters could not be localized on postoperative computerized tomography (CT) scans and were excluded from the analysis. The perfusates were analyzed at the patient's bedside for levels of glucose, pyruvate, lactate, glutamate, and glycerol with the aid of a CMA 600 Analyzer. The positions of eight (22%) of the 36 catheters were reclassified after a review of findings on CT scans. Except for pyruvate the values of all biochemical variables and the lactate/pyruvate (L/P) ratio were significantly different in the penumbra zone when compared with mean values found in "normal" tissue ipsilateral to the parenchymal damage and in contralateral normal tissue (p <0.001). In the penumbra zone a slow normalization of the L/P ratio and levels of glutamate and glycerol were observed. In normal tissue these parameters remained within normal limits. Conclusions. Data obtained from intracerebral microdialysis can be correctly interpreted only if the locations of the catheters as they relate to focal brain lesions are visualized. A "biochemical penumbra zone" surrounds focal traumatic brain lesions. It remains to be proven whether therapeutic interventions can protect the penumbra zone from permanent damage.

KW - Brain trauma

KW - Microdialysis

KW - Penumbra zone

UR - http://www.scopus.com/inward/record.url?scp=16244415575&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=16244415575&partnerID=8YFLogxK

U2 - 10.3171/jns.2005.102.3.0460

DO - 10.3171/jns.2005.102.3.0460

M3 - Article

C2 - 15796380

AN - SCOPUS:16244415575

VL - 102

SP - 460

EP - 469

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 3

ER -