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Cerebral Vascular Changes During Acute Intracranial Pressure Drop

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Abstract

Objective

This study applied a new external ventricular catheter, which allows intracranial pressure (ICP) monitoring and cerebral spinal fluid (CSF) drainage simultaneously, to study cerebral vascular responses during acute CSF drainage.

Methods

Six patients with 34 external ventricular drain (EVD) opening sessions were retrospectively analyzed. A published algorithm was used to extract morphological features of ICP recordings, and a template-matching algorithm was applied to calculate the likelihood of cerebral vasodilation index (VDI) and cerebral vasoconstriction index (VCI) based on the changes of ICP waveforms during CSF drainage. Power change (∆P) of ICP B-waves after EVD opening was also calculated. Cerebral autoregulation (CA) was assessed through phase difference between arterial blood pressure (ABP) and ICP using a previously published wavelet-based algorithm.

Results

The result showed that acute CSF drainage reduced mean ICP (P = 0.016) increased VCI (P = 0.02) and reduced ICP B-wave power (P = 0.016) significantly. VCI reacted to ICP changes negatively when ICP was between 10 and 25 mmHg, and VCI remained unchanged when ICP was outside the 10–25 mmHg range. VCI negatively (r = − 0.44) and VDI positively (r = 0.82) correlated with ∆P of ICP B-waves, indicating that stronger vasoconstriction resulted in bigger power drop in ICP B-waves. Better CA prior to EVD opening triggered bigger drop in the power of ICP B-waves (r = − 0.612).

Conclusions

This study demonstrates that acute CSF drainage reduces mean ICP, and results in vasoconstriction which can be detected through an index, VCI. Cerebral vessels actively respond to ICP changes or cerebral perfusion pressure (CPP) changes in a certain range; beyond which, the vessels are insensitive to the changes in ICP and CPP.

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Funding

This work was partially supported by the UCSF Middle Career Scientist Award, UCSF Institute for Computational Health Sciences, and National Institutes of Health awards (R01NS076738 and NS106905-01A1).

Author information

Authors and Affiliations

  1. Department of Physiological Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA

    Xiuyun Liu, Nhi Ho & Xiao Hu

  2. Department of Neurosurgery, School of Medicine, University of California, Los Angeles, USA

    Paul Vespa & Xiao Hu

  3. Department of Neurological Surgery, University of California, Davis, CA, USA

    Lara L. Zimmermann

  4. Chongqing Engineering Laboratory of Nano/Micro Biological Medicine Detection Technology, Institute of Biomedical Engineering, Chongqing University of Science and Technology, Chongqing, People’s Republic of China

    Xiaoling Liao

  5. Department of Neurological Surgery, University of California, San Francisco, USA

    Xiao Hu

  6. Institute of Computational Health Sciences, University of California, San Francisco, USA

    Xiao Hu

Authors
  1. Xiuyun Liu
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  2. Lara L. Zimmermann
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  3. Nhi Ho
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  4. Paul Vespa
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Contributions

The concept and study design were formed by X.H., X.Y.L., P.V., L.Z. and X.L.L. Data acquisition was conducted by P.V., N.H. and L.Z. Data analysis was conducted by X.Y.L., N.H., X.L.L and X.H. Drafting of the manuscript and figures was contributed by X.Y.L., X.H., L.Z., P.V., N.H. and X.L.L.

Corresponding author

Correspondence to Xiuyun Liu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The institutional review board (IRB) approved the data analysis and waived the need for consenting patients because of the retrospective nature of the study.

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Liu, X., Zimmermann, L.L., Ho, N. et al. Cerebral Vascular Changes During Acute Intracranial Pressure Drop. Neurocrit Care 30, 635–644 (2019). https://doi.org/10.1007/s12028-018-0651-4

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  • DOI: https://doi.org/10.1007/s12028-018-0651-4

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