Schettini A, Walsh E K
Research Service, Veterans Administration Medical Center, Richmond.
Am J Physiol. 1988 Nov;255(5 Pt 2):R799-805. doi: 10.1152/ajpregu.1988.255.5.R799.
This study was designed to test the hypothesis that the progressive expansion of an extradural mass causes detectable changes in brain mechanical response properties, in particular the nonlinear elastic behavior, before any significant changes in intracranial cerebrospinal fluid pressure can be detected. In 10 chronically prepared and anesthetized dogs, incremental inflation (0.07 ml/s) of an extradural balloon caused 1) a progressive fall in the brain nonlinear elastic parameter (G0, mmHg/mm2), 2) nonsignificant changes in brain tissue elasticity (G0, mmHg/mm), 3) a disproportionate progressive rise in subpial tension, and 4) a progressive fall in local cerebral blood flow (H2 clearance), despite a modest decrease in cerebral perfusion pressure (extracranial). In previous brain compression experiments (Brain Res. 305: 141-143, 1984) we have shown that the compression site becomes compacted and stiffer (increased G0) and its nonlinear elastic parameter (G0) increases markedly. These earlier findings, coupled with the present observation of a loss in tissue nonlinearity distally to the compression site, are most likely the major mechanisms by which, with a rapidly expanding intracranial mass, tissue pressure gradients and brain displacement, including transtentorial herniation, develop.
在颅内脑脊液压力出现任何显著变化之前,硬膜外肿块的渐进性扩张会导致大脑力学响应特性发生可检测到的变化,尤其是非线性弹性行为。在10只长期制备并麻醉的狗身上,硬膜外球囊以递增方式充气(0.07 ml/s),导致:1)大脑非线性弹性参数(G0,mmHg/mm2)逐渐下降;2)脑组织弹性(G0,mmHg/mm)无显著变化;3)软脑膜下张力不成比例地逐渐升高;4)尽管脑灌注压(颅外)略有下降,但局部脑血流量(H2清除率)逐渐下降。在之前的脑压迫实验(《脑研究》305: 141 - 143, 1984)中,我们已经表明压迫部位会变得致密且更硬(G0增加),其非线性弹性参数(G0)显著增加。这些早期发现,再加上目前观察到的压迫部位远端组织非线性的丧失,很可能是随着颅内肿块迅速扩大,组织压力梯度和脑移位(包括小脑幕切迹疝)发展的主要机制。