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Slow vasogenic fluctuations of intracranial pressure and cerebral near infrared spectroscopy—an observational study

  • Clinical research
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Abstract

Background/purpose

Increased slow-wave activity in intracranial pressure (ICP) signifies an exhausted cerebrospinal compensatory reserve across a range of conditions. In this study, we attempted to describe synchronisation between slow waves of ICP and of near-infrared spectroscopy (NIRS) variables during controlled elevation of ICP.

Method

Nineteen patients presenting with symptomatic hydrocephalus underwent a Computerised Infusion Test. NIRS-derived indices, ICP and arterial blood pressure (ABP) were recorded simultaneously.

Findings

ICP increased from 9.3 (6.0) mmHg to a 17.1 (8.9) mmHg during infusion. Slow waves in ICP were accompanied by concurrent waves in each NIRS variable (including deoxygenated haemoglobin (Hb) and oxygenated haemoglobin (HbO2)) with a mean coherence of >0.7 and no significant phase shift. In the same bandwidth (0.3–1.8 min−1), ABP fluctuations occurred with a coherence of 0.77 and phase lead of 40° with respect to ICP. The power of ICP slow waves increased significantly during infusion plateau with a corresponding increase in power of Hb waves.

Conclusions

Slow fluctuations in cerebral oximetry as detected by NIRS coincide with and are implicated in the origin of ICP slow waves and increases during periods of exhausted cerebrospinal compensatory reserve. NIRS may be used as a non-invasive marker of increased ICP slow waves (and therefore reduced CSF compensatory reserve).

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Acknowledgements

The project was supported by the National Institute of Health Research Biomedical Research centre, Cambridge University Hospital Foundation Trust—Neurosciences Theme.

JDP is supported by the NIHR Senior Investigator Award.

CZ is supported by the Swiss National Science Foundation (PBBSP3-125550), Bern, Switzerland.

NK is supported by the Joint Royal College of Surgeons/Dunhill Medical Trust Fellowship and the Tunku Abdul Rahman Project Grant

Conflicts of interest and disclosures

ICM + software (www.neurosurg.cam.ac.uk/icmplus) is licenced by the University of Cambridge, Cambridge Enterprise Ltd. PS and MC have a financial interest in a part of the licencing fee.

CZ received a travel grant from Hamamatsu Photonics, Welwyn Garden City, Hertfordshire, UK.

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Authors and Affiliations

  1. University of Cambridge Academic Neurosurgery Unit, Addenbrooke’s Hospital, Cambridge, UK

    Ruwan A. Weerakkody, Marek Czosnyka, Christian Zweifel, Gianluca Castellani, Piotr Smielewski, Nicole Keong, Christina Haubrich, John Pickard & Zofia Czosnyka

  2. Department of Surgery, The Alfred Hospital, Melbourne, VIC 3181, Australia

    Ruwan A. Weerakkody

Authors
  1. Ruwan A. Weerakkody
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  2. Marek Czosnyka
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  3. Christian Zweifel
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  4. Gianluca Castellani
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  5. Piotr Smielewski
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  6. Nicole Keong
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  7. Christina Haubrich
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  8. John Pickard
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  9. Zofia Czosnyka
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Corresponding author

Correspondence to Ruwan A. Weerakkody.

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Comments

The present study shows both correlation and coherence between ICP slow/B waves and NIRS derived slow waves in controlled increase of ICP. Although the results are robust the significance of B waves is still under discussion and thus the practical implications pending.

Peter Siesjo

Lund, Sweden

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Weerakkody, R.A., Czosnyka, M., Zweifel, C. et al. Slow vasogenic fluctuations of intracranial pressure and cerebral near infrared spectroscopy—an observational study. Acta Neurochir 152, 1763–1769 (2010). https://doi.org/10.1007/s00701-010-0748-9

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  • DOI: https://doi.org/10.1007/s00701-010-0748-9

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