Summary
Intracarotid mannitol (HBBBD = hyperosmotic BBB disruption) as a method of transiently increasing solute/drug delivery to brain parenchyma has been associated in animals with a 1-2% increase in brain water and an increase in cisternal ICP. To determine whether these changes are clinically significant, we investigated ICP changes associated with HBBBD in 33 patients with malignant brain tumor utilizing flash VERs in which the N2 latency correlates well with ICP (N2 &jt; 80 ms linearly corresponds to ICP &jt; 20 cm H2O). VERs were obtained prior to, 4 and 24 h after 114 HBBBD/ chemotherapy procedures. Additionally, in 10 patients (37 HBBBDs), VER monitoring was performed during the procedure. In 112/150 (75%) HBBBDs, good barrier opening was obtained (radionuclide brain scan). Postoperative mean N2 latencies did not differ significantly from pre-HBBBD values (N2 = 86 ± 3.3 pre, 90 ± 3.0 / 4 h, 87 ± 3.6 / 24 h); there was no significant difference in N2 latencies in those patients with good vs poor BBBD. In the 10 patients monitored during HBBBD, peak N2 latency = 94.9 ± 1.6, however, was significantly above pre- and post-HBBBD values (p < 0.04). We conclude that flash VERs are a useful noninvasive measure of ICP, and that HBBBD is associated with mild transient increase in ICP which is not clinically detrimental.
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References
Burrows F A, Hillier S C, McLeod M E, Iron K S, Taylor M J (1990) Anterior fontanel pressure and visual evoked potentials in neonates and infants undergoing profound hypothermic circulatory-arrest. Anesthesiology 73: 632–636
Connolly M B, Jan J E, Cochrane D D (1991) Rapid recovery from cortical visual impairment following correction of prolonged shunt malfunction in congenital hydrocephalus. Arch Neurol 48: 956–957
Coupland S G, Cochrane D D (1987) Visual evoked potentials, intracranial pressure and ventricular size in hydrocephalus. Doc Ophthalmol 66: 321–330
Gumerlock M K, Belshe B D, Madsen R, Watts C (1992) Osmotic blood-brain barrier disruption and chemotherapy in the treatment of high grade malignant glioma: patient series and literature review. J Neurooncol 12: 33–46
Neuwelt E A, Frenkel E P, Rapoport S, et al (1980) Effect of osmotic blood-brain barrier disruption on methotrexate pharmacokinetics in the dog. Neurosurgery 7: 36–43
York D H, Pulliam M W, Rosenfeld J G, Watts C (1981) Relationship between visual evoked potentials and intracranial pressure. J Neurosurg 55: 909–916
York D H, Leagan M, Benner S, Watts C (1984) Further studies with a noninvasive method of intracranial pressure estimation. Neurosurgery 14: 456–461
Zaaroor M, Pratt H, Feinsod M, Schacham S E (1993) Real-time monitoring of visual evoked potentials. Isr J Med Sei 29:17–22
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© 1994 Springer-Verlag
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Gumerlock, M.K., York, D., Durkis, D. (1994). Visual Evoked Responses as a Monitor of Intracranial Pressure During Hyperosmolar Blood-Brain Barrier Disruption. In: Ito, U., et al. Brain Edema IX. Acta Neurochirurgica, vol 60. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9334-1_35
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DOI: https://doi.org/10.1007/978-3-7091-9334-1_35
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-9336-5
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