Abstract
Introduction
Cerebral autoregulation is an essential mechanism for maintaining cerebral blood flow stability. The phenomenon of transtentorial intracranial pressure (ICP) gradient after neurosurgical operations, complicated by edema and intracranial hypertension in the posterior fossa, has been described in clinical practice but is still underinvestigated. The aim of the study was to compare autoregulation coefficients (i.e., pressure reactivity index [PRx]) in two compartments (infratentorial and supratentorial) during the ICP gradient phenomenon.
Methods
Three male patients, aged 24 years, 32 years, and 59 years, respectively, were involved in the study after posterior fossa surgery. Arterial blood pressure and ICP were invasively monitored. Infratentorial ICP was measured in the cerebellar parenchyma. Supratentorial ICP was measured either in the parenchyma of the cerebral hemispheres or through the external ventricular drainage. Cerebral autoregulation was evaluated by the PRx coefficient (ICM + , Cambridge, UK).
Results
In all patients, ICP was higher in the posterior fossa, and the transtentorial ICP gradient in each patient was 5 ± 1.6 mm Hg, 8.5 ± 4.4 mm Hg, and 7.7 ± 2.2 mm Hg, respectively. ICP in the infratentorial space was 17 ± 4 mm Hg, 18 ± 4.4 mm Hg, and 20 ± 4 mm Hg, respectively. PRx values in the supratentorial and infratentorial spaces had the smallest difference (− 0.01, 0.02, and 0.01, respectively), and the limits of precision were 0.1, 0.2, and 0.1 in the first, second, and third patients, respectively. The correlation coefficient between the PRx values in the supratentorial and infratentorial spaces for each patient was 0.98, 0.95, and 0.97, respectively.
Conclusions
A high degree of correlation was established between the autoregulation coefficient PRx in two compartments in the presence of transtentorial ICP gradient and persistent intracranial hypertension in the posterior fossa. Cerebral autoregulation, according to the PRx coefficient in both spaces, was similar.
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Funding
DB was supported by National Institutes of Health RO1 NS112808.
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AO performed data collection, assisted in the data analysis, and contributed to article preparation. AG assisted with data collection and contributed to article preparation. IS provided overall study design, assisted with data collection, performed primary analysis, and contributed to article preparation. EA assisted with study design, assisted with analysis. DB assisted with study design, assisted with analysis, contributed to article preparation, and finalized the article. All authors contributed to the article and approved the submitted version.
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The study conformed to the Declaration of Helsinki standards and was approved by the Burdenko Institute Ethics Committee.
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Oshorov, A., Gavrjushin, A., Savin, I. et al. Comparison of Cerebral Autoregulation Above and Below the Tentorium of the Cerebellum In Neurosurgical Patients with Transtentorial ICP Gradient. Neurocrit Care 39, 419–424 (2023). https://doi.org/10.1007/s12028-023-01696-3
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DOI: https://doi.org/10.1007/s12028-023-01696-3