Conceptos básicos sobre la fisiopatología cerebral y la monitorización de la presión intracraneal

Rodríguez-Boto, G.; Rivero-Garvía, Mónica; Gutiérrez-González, Raquel; Márquez-Rivas, Javier

doi:10.1016/j.nrl.2012.09.002

Cited by 41 publications

(25 citation statements)

References 15 publications

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“…Hydrodynamically, the intracranial system of a healthy individual can be simplified into three components, i.e. brain, CSF and blood 21 . In a pneumocephalus patient, a fourth component, the ICA, is present.…”

Section: Hydrodynamics Of Intracranial Pressurementioning

confidence: 99%

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

Lim

Lan

Ooi

et al. 2020

Sci Rep

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This study investigates the effects of aircraft cabin pressure on intracranial pressure (ICP) elevation of a pneumocephalus patient. We propose an experimental setup that simulates the intracranial hydrodynamics of a pneumocephalus patient during flight. It consists of an acrylic box (skull), air-filled balloon [intracranial air (ICA)], water-filled balloon (cerebrospinal fluid and blood) and agarose gel (brain). The cabin was replicated using a custom-made pressure chamber. The setup can measure the rise in ICP during depressurization to levels similar to that inside the cabin at cruising altitude. ΔICP, i.e. the difference between mean cruising ICP and initial ICP, was found to increase with ICA volume and ROC. However, ΔICP was independent of the initial ICP. The largest ΔICP was 5 mmHg; obtained when ICA volume and ROC were 20 ml and 1,600 ft/min, respectively. The postulated ICA expansion and the subsequent increase in ICP in pneumocephalus patients during flight were successfully quantified in a laboratory setting. Based on the quantitative and qualitative analyses of the results, an ICA volume of 20 ml and initial ICP of 15 mmHg were recommended as conservative thresholds that are required for safe air travel among pneumocephalus patients. This study provides laboratory data that may be used by doctors to advise post-neurosurgical patients if they can safely fly. Craniotomy refers to the surgical removal of a portion of the skull to gain access to the contents of the intracranial cavity. The procedure usually involves exposing the brain after opening its membranous coverings 1 , which inevitably expose the human brain to surrounding air. Varying amounts of air within the intracranial cavity (ICA) (known as pneumocephalus) remain after craniotomy 2. In most cases, pneumocephalus is not life-threatening as the ICA is normally absorbed into the systemic circulation over a period of several weeks 3-5. Safety concerns arise when patients with pneumocephalus engage in air travel before the ICA is fully absorbed. Air safety regulations require cabins of commercial aircraft to be pressurized to a standardized minimum of 75 kPa, which is approximately 75% that of atmospheric pressure at sea level (101.3 kPa), at cruising altitude 6,7. Consequently, during air travel, the ambient pressure may be as much as 25 kPa lower than the initial pressure of the ICA, which is at 101.3 kPa. According to Boyle's law, the difference in pressure between the aircraft cabin and the ICA would result in an increase in the ICA volume, as the ICA expands to equilibrate with the cabin pressure. The expansion, which takes place inside the rigid cranium, may cause cerebral compression that can lead to elevations in the intracranial pressure (ICP). A mild increase in ICP is tolerable. However, if the increase in ICP is too large, cerebral herniation may occur, which severely endangers the life of the pneumocephalus patient. In spite of the potential life-threatening event, pneumocephalus and air travel safety remains a controversial topic 8...

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Section: Hydrodynamics Of Intracranial Pressurementioning

confidence: 99%

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

Lim

Lan

Ooi

et al. 2020

Sci Rep

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“…CBF regulation is possible through neurogenic, myogenic, metabolic, or endothelial control to support CBF at an appropriate level for the brain's metabolic oxygen requirements [6]. However, when the upper or lower limits of these autoregulatory mechanisms are exceeded, CBF becomes absolutely dependent on mean arterial pressure (MAP) [7]. Under normal, physiological conditions, the graphic recording of ICP is stable and regular, and ICP depends on CSF production volume, system resistance to reabsorption of CSF, and venous pressure in the intracranial space [7].…”

Section: Cerebral Blood Flow and Intracranial Pressurementioning

confidence: 99%

“…However, when the upper or lower limits of these autoregulatory mechanisms are exceeded, CBF becomes absolutely dependent on mean arterial pressure (MAP) [7]. Under normal, physiological conditions, the graphic recording of ICP is stable and regular, and ICP depends on CSF production volume, system resistance to reabsorption of CSF, and venous pressure in the intracranial space [7]. Another important variable is compliance, defined as the change in volume in response to a change in pressure.…”

Section: Cerebral Blood Flow and Intracranial Pressurementioning

confidence: 99%

Cerebral Blood Flow in Low Intracranial Pressure Headaches—What Is Known?

Nowaczewska

Kaźmierczak

2019

Brain Sciences

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Headaches attributed to low cerebrospinal fluid (CSF) pressure are described as orthostatic headaches caused by spontaneous or secondary low CSF pressure or CSF leakages. Regardless of the cause, CFS leaks may lead to intracranial hypotension (IH) and influence cerebral blood flow (CBF). When CSF volume decreases, a compensative increase in intracranial blood volume and cerebral vasodilatation occurs. Sinking of the brain and traction on pain-sensitive structures are thought to be the causes of orthostatic headaches. Although there are many studies concerning CBF during intracranial hypertension, little is known about CBF characteristics during low intracranial pressure. The aim of this review is to examine the relationship between CBF, CSF, and intracranial pressure in headaches assigned to low CSF pressure.

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“…As stated by Monroe-Kelly doctrine [50,51], «the sum of the intracranial volumes of blood, brain, CSF and other components is constant and that an in increase in any one of these must be offset by an equal decrease in another» [52], so the skull is a rigid structure, inextensible, in order to maintain a constant blood pressure, the volumes inside the cranium should be constant. Any increase or an additional volume (e.g., haematomas, oedema, hyperemia), will carry an increase in the ICP, and must result in a decrease in the others.…”

Section: Intracranial Hypertension (Ich)mentioning

confidence: 99%

Decompressive craniectomy in traumatic brain injury: Quo Vadis?

et al. 2014

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Intracranial hypertension is the leading cause of mortality in patients with cranial injury. Currently the traumatic brain injury is a public health problem worldwide. Decompressive craniectomy emerges as a treatment strategy for patients with refractory intracranial hypertension. The completed surgery requires careful surgical technique and exquisite. We present a review of the literature about the technique.

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Conceptos básicos sobre la fisiopatología cerebral y la monitorización de la presión intracraneal

Abstract: Correct monitoring of ICP is fundamental for diagnosing ICH, and even more importantly, providing appropriate treatment in a timely manner.

Cited by 41 publications

References 15 publications

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

Cerebral Blood Flow in Low Intracranial Pressure Headaches—What Is Known?

Decompressive craniectomy in traumatic brain injury: Quo Vadis?

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