Effect of supratentorial space-occupying lesions on regional intracranial pressure and local cerebral blood flow: an experimental study in baboons

Symon, Lindsay; Pásztor, E.; Branston, Neil M.; Dorsch, Nicholas W.C.

doi:10.1136/jnnp.37.6.617

Cited by 49 publications

(18 citation statements)

References 19 publications

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“…The mean supratentorial CPP close to 60 mm Hg at stage 2 is in agreement with the results of many others who found autoregulatory activity retained at this CPP level 7,14,21,22,24,31,32,37,38,40 The supratentorial CPP close to 30 mm Hg, at isoelectric EEG is also in agreement with previous studies 28, 34, 35, 40, 42. It is also consistent with a haematoma volume which exceeds the known volume tolerance of the animal 13. The reduction of supratentorial rCBF values to 50% or less of the control value, at the time the EEG became isoelectric is also in good agreement both with the observed supratentorial CPP and the observations of other authors 1-3, 1o, 40.…”

Section: Discussionsupporting

confidence: 93%

“…The use of a catheter in the right cerebral ventricle, to measure the supratentorial pressure, and form the basis for CPP calculations for both sides, seemed justified. Herniation under the falx, as described by Symon et al 37 with an expanding epidural balloon, in a baboon model, was not seen. This is due to the minimal falx found in the pigs used in this study.…”

Section: Discussionmentioning

confidence: 84%

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Cerebral blood flow during experimental epidural bleeding in swine

Ganz

Hall²,

Zwetnow³

1990

Acta neurochir

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Regional cerebral blood flow (rCBF) was studied during an aggressive epidural bleed, using a ventilated swine model. rCBF, regional organ blood flow and cardiac output were measured using the radioactive microsphere technique. Blood flows were measured prior to the start of bleeding (Stage 1), when intracranial pressures had reached a plateau and supratentorial perfusion pressure was reduced by about 50% (Stage 2), and at isoelectric EEG (Stage 3). Supratentorial rCBF did not change significantly between stages 1 and 2 while rCVR decreased, implying autoregulatory activity. Cerebral ischaemia developed between stages 2 and 3 when rCBF values fell to levels between 20 and 50% of control values. Infratentorial rCBF changes were similar but less marked, so that adequate brain stem perfusion was maintained below the upper mesencephalon. The left temporal and left parietal cortex and upper mesencephalon suffered a greater reduction in rCBF than other regions, due to proximity to the haematoma and tentorial herniation. The supratentorial perfusion pressure at stage 2 was 60 mm Hg associated with a haematoma volume of 6% of the intracranial volume (ICV). The infratentorial perfusion pressure never fell below 60 mm Hg. The Cushing response was absent when the EEG became isoelectric. This is tentatively ascribed to the absence of hypoxia, because mechanical ventilation was used. Instead systemic arterial hypotension accompanied bleeding in this ventilated model. This hypotension was due to falling cardiac output and peripheral vasodilation.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 84%

Cerebral blood flow during experimental epidural bleeding in swine

Ganz

Hall²,

Zwetnow³

1990

Acta neurochir

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“…17 All of these patients presented with higher ICP in the ipsilateral hemisphere to the greatest mass lesion volume. In experimental animal models, Symon et al 20 using an extradural balloon and four different extradural transducers, found that ICP in the ipsilateral supratentorial compartment became significantly higher than those in the contralateral side. In the study of Sahuquillo et al, 17 the highest ICP was never found in the side contralateral to the hemisphere with the higher volume.…”

Section: Interhemispheric Gradients In Focal Lesionsmentioning

confidence: 97%

“…The main conclusion of the study was that the speed of growth of the intracranial space-occupying lesion may be critical in the development of supratentorial ICP gradients and that transient ICP gradients may be the most common ICP pattern found between both hemispheres in the presence of mass lesions. 19 In a baboon model, in which mass lesions were induced by a posterior parietooccipital extradural balloon, Symon et al 20 demonstrated the existence of significant interhemispheric differences in calculated CPP. When the ICP level was lower than 10 mm Hg, the pressure measured in the four selected extradural points (frontal and parietal bilaterally) were almost identical.…”

Section: Experimental Conditionmentioning

confidence: 98%

Different Compartments of Intracranial Pressure and Its Relationship to Cerebral Blood Flow

Schaller

Graf

2005

The Journal of Trauma: Injury, Infection, and Critical Care

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“…There is some experimental evidence to suggest that one third to a quarter of the CSF is absorbed through the spinal theca by the arachnoid granulations along the spinal roots [25]. A congenital or acquired reduction in the number and impairment of the absorptive ability of spinal arachnoid granulations or functional exclusion of this absorptive area from the flow of CSF by an obstruction such as a spinal cyst would result in a gradual increase in CSF volume, which in the absence of compensatory mechanisms would raise CSF pressure.…”

Section: Spinal Arachnoid Granulations -Reduced Absorptionmentioning

confidence: 99%