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Brain Microdialysis Monitoring

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Neurocritical Care for Neurosurgeons

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Abstract

Cerebral microdialysis (CMD) is a tool increasingly used in neurocritical care units in the management of patients with severe traumatic brain injury and aneurysmal subarachnoid hemorrhage who are comatose. In the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care, CMD monitoring was recommended in patients with or at risk of cerebral ischemia, hypoxia, energy failure, and glucose deprivation. CMD allows knowing, in near real-time, the dynamic changes in the extracellular brain tissue levels of the metabolites involved in cerebral energy substrate delivery and energy metabolism (glucose, pyruvate, and lactate) and to carry out, with some temporal limitations, bedside sequential measurements of ions and various molecules of interest in the injured brain. At present, this technique has progressed from the laboratory to the clinic and progressively is being introduced in the monitoring of neurocritical patients since it offers important neurometabolic information complementary to the variables that are routinely monitored in these patients (intracranial pressure, cerebral perfusion pressure, and cerebral oximetry). In this chapter, we review the rationale and fundamentals of microdialysis techniques, describe basic methodological aspects, and update the possibilities of this powerful brain monitoring technique. CMD combined with methods of brain oxygen monitoring allows a systematic approach to the different classes of brain hypoxia and the disrupted metabolic profiles found after acute brain injury.

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Acknowledgments

We would like to thank all the nurses of the neuroICU of the VHUH for their continuous help. This work was supported in part by the Fondo de Investigación Sanitaria (Instituto de Salud Carlos III) with grant PI15/01228, which was co-financed by the European Regional Development and awarded to Dr. J. Sahuquillo and by the grants KidsBrainIT (ERA-NET NEURON), co-financed by the European Regional Development Fund (ERDF), and grant 20172430 from the Marató de TV3, awarded to Dr. J. Sahuquillo and Dr. M.A. Poca, respectively.

Disclosure Statement

The authors report no conflict of interest concerning the materials or methods mentioned in this chapter.

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Authors and Affiliations

  1. Department of Neurosurgery, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron, Barcelona, Spain

    Maria A. Poca & Juan Sahuquillo

  2. Neurotrauma and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron, Barcelona, Spain

    Maria A. Poca, David Sanchez-Ortiz & Juan Sahuquillo

  3. Universitat Autònoma de Barcelona, Bellaterra, Spain

    Maria A. Poca & Juan Sahuquillo

  4. Neurotraumatology Intensive Care Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron, Barcelona, Spain

    Jacinto Baena

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  1. Maria A. Poca
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  2. David Sanchez-Ortiz
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  3. Jacinto Baena
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  4. Juan Sahuquillo
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Correspondence to Maria A. Poca .

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Editors and Affiliations

  1. University of São Paulo, São Paulo, Brazil

    Eberval Gadelha Figueiredo

  2. State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil

    Leonardo C. Welling

  3. University of Sao Paulo, São Paulo, São Paulo, Brazil

    Nícollas Nunes Rabelo

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Poca, M.A., Sanchez-Ortiz, D., Baena, J., Sahuquillo, J. (2021). Brain Microdialysis Monitoring. In: Figueiredo, E.G., Welling, L.C., Rabelo, N.N. (eds) Neurocritical Care for Neurosurgeons. Springer, Cham. https://doi.org/10.1007/978-3-030-66572-2_7

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