Department of Neurology, Neurosurgery and Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY, United States; Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States.
Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States.
J Neurol Sci. 2018 Jul 15;390:184-192. doi: 10.1016/j.jns.2018.03.032. Epub 2018 Mar 28.
Elevated intracranial pressure (ICP) following brain injury contributes to poor outcomes for patients, primarily by reducing the caliber of cerebral vasculature, and thereby reducing cerebral blood flow. Careful monitoring of ICP is critical in these patients in order to determine prognosis, implement treatment when ICP becomes elevated, and to judge responsiveness to treatment. Currently, the gold standard for monitoring is invasive pressure transducers, usually an intraventricular monitor, which presents significant risk of infection and hemorrhage. These risks made discovering non-invasive methods for monitoring ICP and cerebral perfusion a priority for researchers. Herein we sought to review recent publications on novel minimally invasive multi-modality monitoring techniques that provide surrogate data on ICP, cerebral oxygenation, metabolism and blood flow. While limitations in various forms preclude them from supplanting the use of invasive monitors, these modalities represent useful screening tools within our armamentarium that may be invaluable when the risks of invasive monitoring outweigh the associated benefits.
颅脑损伤后继发颅内压升高会导致患者预后不良，主要是通过降低脑血管口径，从而减少脑血流。为了确定预后、在颅内压升高时实施治疗，并判断对治疗的反应，对这些患者进行仔细的颅内压监测至关重要。目前，监测的金标准是侵入性压力传感器，通常是脑室内监测器，但这会带来严重的感染和出血风险。这些风险使得研究人员优先考虑发现非侵入性监测颅内压和脑灌注的方法。在此，我们旨在回顾最近关于新型微创多模态监测技术的出版物，这些技术提供了颅内压、脑氧合、代谢和血流的替代数据。虽然各种形式的局限性使它们无法替代侵入性监测器的使用，但这些方式在我们的治疗手段中是有用的筛选工具，当侵入性监测的风险超过其相关益处时，它们可能具有无法估量的价值。
