A Non-invasive Assessment of Intracranial Volume Reserve by Measuring Cerebrospinal Fluid Volume with the Aid of CT Imaging
Monitoring changes in the intracranial volume (ICV) reserve and intracranial pressure (ICP) is one of the key issues in the treatment of intracranial pathologies. The aim of this study is to develop a method of monitoring the ICV reserve by analyzing CSF volume measured using CT in specific regions.
Materials and Methods
A total of 20 patients with cerebral injury were evaluated. Analysis was performed using imaging software. On selected scans (three at the basal cistern level and three at the pineal level), the following regions were analyzed: total cerebral surface (TC1, TC2) and bilateral ambient cistern (AC) only at the basal cistern level for cerebrospinal fluid (CSF) volume. Results were correlated with patients’ Glasgow Coma Scale (GCS) scores.
An increase of CSF volume was observed with an improvement in the GCS. From the examined regions, only AC volume showed a statistically significant linear correlation (p < 0.0005) with GCS. Mean AC: 0.021, 0.454, and 0.678 mL CSF/scan in severe (3–8 pts GCS), moderate (9–12 pts GCS), and mild (13–15 pts GCS) TBI groups, respectively.
Assessment of CSF volume changes in mL CSF/scan can be conducted using CT. Counting voxels corresponding to the CSF eliminates mistakes due to inaccurate region demarcation. The obtained results (AC volume) show a high correlation with patient state.
KeywordsIntracranial pressure intracranial volume reserve traumatic brain injury non-invasive ICP monitoring voxel
- 4.Czernicki Z, Walecki J (1990) Evaluation of oedema spreading and intracranial volume reserve using CT image numerical analysis. Acta Neurochir Suppl (Wien) 51:407–408Google Scholar
- 6.Czernicki Z, Głowacki M, Walecki J, Jurkiewicz J, Walasek N (2007) Optimalization of the neurosurgical care – a multicentre telemedical project. In: International Proceedings, reprinted from 13th European Congress of Neurosurgery, Glasgow, September, 2–7, 719–722Google Scholar
- 7.Czosnyka M, Pickard JD (2004) Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry Jun; 75(6):813–821Google Scholar
- 8.Fountas KN, Sitkauskas A, Feltes CH, Kapsalaki EZ, Dimopoulos VG, Kassam M, Grigorian AA, Robinson JS, Ragauskas A (2005) Is non-invasive monitoring of intracranial pressure waveform analysis possible? Preliminary results of a comparative study of non-invasive vs. invasive intracranial slow-wave waveform analysis monitoring in patients with brain injury. Med Sci Monit Feb; 11(2):CR58–CR63Google Scholar
- 9.Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J (2008) Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med Nov 34(11). [Epub 2008 May 29; 2062–7]Google Scholar
- 10.Głowacki M, Czernicki Z, Jurkiewicz J (2004) Teleconsulting in multidisciplinary approach to the trauma patient. In: Abstracts of the Proceedings of 9th Congress of the Euroacademia Multidisciplinaria Neurotraumatologica, Bucharest, Romania, 19–22 May; Acta Neurochir (2006) 148:IIGoogle Scholar
- 11.Głowacki M, Czernicki Z, Jurkiewicz J, Walasek N (2005) Teleradiology in neurosurgery, based on the experience of the Department of Neurosurgery, Polish Academy of Sciences. Pol J Radiol 70(4): 27–34Google Scholar
- 12.Głowacki M, Czernicki Z, Mierzejewski M, Jurkiewicz J (2003) Teleconsulting in the Management of Acute Neurotrauma. Euroacademia Multidipsciplinaria Neurotraumatologica 155:61–67Google Scholar
- 13.Głowacki M (2006) Teleradiology in clinical practice. Pol J Radiol 71(4):99–117Google Scholar
- 15.Kroin JS, Nagalla SK, Buvanendran A, McCarthy RJ, Tuman KJ, Ivankovich AD (2002) The mechanisms of intracranial pressure modulation by epidural blood and other injectates in a postdural puncture rat model. Anesth Analg Aug; 95(2): 423–429Google Scholar
- 16.Louis PT, Goddard-Finegold J, Fishman MA, Griggs JR, Stein F, Laurent JP (1993) Barbiturates and hyperventilation during intracranial hypertension. Crit Care Med Aug; 21(8):1200–1206Google Scholar
- 17.Mauritz W, Steltzer H, Bauer P, Dolanski-Aghamanoukjan L, Metnitz P (2008) Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study. Intensive Care Med Jul; 34(7):1208–1215. Epub 2008 Mar 26Google Scholar
- 18.Narayan RR (1994) Intracranial pressure and CT. J Neurosurg Nov; 81(5):810–811Google Scholar
- 20.Shafi S, Diaz-Arrastia R, Madden C, Gentilello L (2008) Intracranial pressure monitoring in brain-injured patients is associated with worsening of survival. J Trauma Feb; 64(2):335–340Google Scholar
- 21.Styrke J, Stålnacke BM, Sojka P, Björnstig U (2007) Traumatic brain injuries in a well-defined population: epidemiological aspects and severity. J Neurotrauma Sep; 24(9):1425–1436Google Scholar
- 22.Sullivan HG, Miller JD, Becker DP, Flora RE, Allen GA (1977) The physiological basis of intracranial pressure change with progressive epidural brain compression. An experimental evaluation in cats. J Neurosurg Oct; 47(4):532–550Google Scholar
- 23.Ueno T, Macias BR, Yost WT, Hargens AR (2005) Noninvasive assessment of intracranial pressure waveforms by using pulsed phase lock loop technology. Technical note. J Neurosurg Aug; 103(2):361–367Google Scholar