Skip to main content

Advertisement

Log in

Intracerebral microdialysis in children

  • Focus Session
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

Cerebral microdialysis is a relatively new, minimally invasive technique that permits sampling and analyzing the chemical constituents of the extracellular fluid. Although mainly used as a research tool, it is also used in the neurointensive care, in combination with other monitoring methods, in patients with severe traumatic brain injury and subarachnoid hemorrhage. Its main clinical utility is the identification of markers of ischemia and cell damage with the ultimate goal of preventing any secondary insults to the brain by instituting early appropriate treatment measures. With few exceptions, all the available data on intracerebral microdialysis in humans comes from studies performed in adults.

Objective

The purpose of this report is to provide a brief review of the intracerebral microdialysis studies performed in children.

Conclusion

Differences in trends of concentrations of structural and excitatory amino acids have been identified in children, in comparison to those observed in adults, the significance of which remains unknown at present.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Adelson PD, Kochanek PM (1998) Head injury in children. J Child Neurol 13:2–15

    Article  CAS  PubMed  Google Scholar 

  2. Adelson PD, Bratton SL, Carney NA, Chestnut RM, Du Coudray HEM, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents. Pediatr Crit Care Med 4:S1–S71

    Article  Google Scholar 

  3. Ahlsson F, Gedeborg R, Hesselager G, Tuvemo T, Enblad P (2004) Treatment of extreme hyperglycemia monitored with intracerebral microdialysis. Pediatr Crit Care Med 5(1):89–92

    Article  PubMed  Google Scholar 

  4. Alessandri B, Doppenberg E, Bullock R, Woodward J, Choi S, Koura S, Young HF (1999) Glucose and lactate metabolism after severe human head injury: influence of excitatory neurotransmitters and injury type. Acta Neurochir Suppl 75:21–24

    CAS  PubMed  Google Scholar 

  5. Bellander BM, Cantais E, Enblad P, Hutchinson P, Nordstrom CH, Robertson C, Sahuquillo J, Smith M, Stocchetti N, Ungerstedt U, Unterberg A, Olsen NV (2004) Consensus meeting on microdialysis in neurointensive care. Int Care Med 30:2166–2169

    Article  Google Scholar 

  6. Bullock R, Zauner A, Woodward JJ, Myseros J, Choi SC, Ward JD et al (1998) Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg 89:507–518

    Article  CAS  PubMed  Google Scholar 

  7. Clausen T, Alves OL, Reinert M et al (2005) Association between elevated brain tissue glycerol levels and poor outcome following severe traumatic brain injury. J Neurosurg 103:233–238

    Article  CAS  PubMed  Google Scholar 

  8. Duck SC, Wyatt DT (1988) Factors associated with brain herniation in the treatment of diabetic ketoacidosis. J Pediatr 113:10–14

    Article  CAS  PubMed  Google Scholar 

  9. Goodman JC, Valadka AB, Gopinath SP, Uzura M, Robertson CS (1999) Extracellular lactate and glucose alterations in the brain after head injury measured by microdialysis. Crit Care Med 27(9):1965–1973

    Article  CAS  PubMed  Google Scholar 

  10. Hillered L, Persson L (1999) Theory and practice of microdialysis—prospect for future clinical use. Acta Neurochir Suppl 75:3–6

    CAS  PubMed  Google Scholar 

  11. Hillered L, Persson L, Nilsson P, Ronne-Engstrom E, Enblad P (2006) Continuous monitoring of cerebral metabolism in traumatic brain injury: a focus on cerebral microdialysis. Curr Opin Crit Care 12:112–118

    Article  PubMed  Google Scholar 

  12. Hlatky R, Valadka AB, Goodman JC et al (2004) Patterns of energy substrates during ischemia measured in the brain by microdialysis. J Neurotrauma 21:984–906

    Article  Google Scholar 

  13. Hutchinson PJA, Al-Rawi PG, O’Connell MT, Gupta AK, Maskell LB, Hutchinson DBA, Pickard JD, Kirkpatrick PJ (2000) On-line monitoring of substrate delivery and brain metabolism in head injury. Acta Neurochir 76:431–435

    CAS  Google Scholar 

  14. Johnston AJ, Gupta AK (2002) Advanced monitoring in the neurology intensive care unit: microdialysis. Curr Opin Crit Care 8:121–127

    Article  PubMed  Google Scholar 

  15. Mahoney CP, Vlcek BW, DelAguila M (1999) Risk factors for developing brain herniation during diabetic ketoacidosis. Pediatr Neurol 21:721–727

    Article  CAS  PubMed  Google Scholar 

  16. Maurer MH, Haux D, Sakowitz OW, Unterberg AW, Kuschinsky W (2007) Identification of early markers for symptomatic vasospasm in human cerebral microdialysate after subarachnoid hemorrhage: preliminary results of a proteome-wide screening. J Cereb Blood Flow Metab 27:1675–1683

    Article  CAS  PubMed  Google Scholar 

  17. Meyerson BA, Linderoth B, Karlsson H et al (1990) Microdialysis in the human brain: extracellular measurements in the thalamus of parkinsonian patients. Life Sci 46:301–308

    Article  CAS  PubMed  Google Scholar 

  18. Newcomb R, Pierce AR, Kano T, Meng W, Bosque-Hamilton P, Taylor L et al (1997) Characterization of mitochondrial glutaminase and amino acids at prolonged times after experimental focal cerebral ischemia. Brain Res 813:103–111

    Article  Google Scholar 

  19. Newcomb R, Sun X, Taylor L, Curthoys N, Giffard RG (1997) Increased production of extracellular glutamate by the mitochondrial glutaminase following neuronal death. J Biol Chem 272:11276–11282

    Article  CAS  PubMed  Google Scholar 

  20. Nilsonn OG, Brandt L, Ungerstedt U, Saveland H (1999) Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 45(5):1176–1185

    Article  Google Scholar 

  21. Nordstrom CH, Reinstrup P, Xu W, Gardenfors A, Ungerstedt U (2003) Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional energy metabolism. Anesthesiology 98:809–814

    Article  PubMed  Google Scholar 

  22. Persson L, Valtysson J, Enblad P, Warme PE, Cesarini K, Lewen A, Hillered L (1996) Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid hemorrhage. J Neurosurg 84:606–616

    Article  CAS  PubMed  Google Scholar 

  23. Rasmussen JS, Schulz M, Kristensen SR, Bjerre P (2004) Delayed neurological deficits detected by an ischemic pattern in the exracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 100:8–15

    Article  Google Scholar 

  24. Reinstrup P, Stahl N, Mellergard P, Uski T, Ungerstedt U, Nordstrom CH (2000) Intracerebral microdialysis in clinical practice: baseline values for chemical markers during wakefulness, anesthesia and neurosurgery. Neurosurgery 47(3):701–710

    Article  CAS  PubMed  Google Scholar 

  25. Richards AD, Tolias CM, Sgouros S, Bowery NG (2003) Extracellular glutamine to glutamate ratio may predict outcome in the injured brain: a clinical microdialysis study in children. Pharmacol Res 48:101–109

    CAS  PubMed  Google Scholar 

  26. Schlenk F, Graetz D, Nagel A, Schmidt M, Sarrafradeh AS (2008) Insulin-related decrease in cerebral glucose despite normoglycemia in aneurysmal subarachnoid hemorrhage. Critical Care 12(1):R9

    Article  PubMed  Google Scholar 

  27. Schneweis S, Grond M, Staub F, Brinker G, Neveling M, Dohmen C, Graf R, Heiss WD (2001) Predictive value of neurochemical monitoring in large middle cerebral artery infarction. Stroke 32:1863–1867

    CAS  PubMed  Google Scholar 

  28. Stahl N, Ungerstedt U, Nordstrom CH (2001) Brain energy metabolism during controlled reduction of cerebral perfusion pressure in severe head injuries. Int Care Med 27:1215–1223

    Article  CAS  Google Scholar 

  29. Tolias CM, Richards CA, Bowery NG, Sgouros S (2002) Extracellular glutamate in the brains of children with severe head injuries: a pilot microdialysis study. Child’s Nerv Syst 18:368–374

    Google Scholar 

  30. Ungerstedt U, Rostami E (2004) Microdialysis in neurointensive care. Curr Pharma Des 10:2145–2152

    Article  CAS  Google Scholar 

  31. Unterberg AW, Sakowitz OW, Sarrafzadeh AS, Benndorf G, Lanksch WR (2001) Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 94:740–749

    Article  CAS  PubMed  Google Scholar 

  32. Valadka AB, Goodman JC, Gopinath SP, Uzura M, Robertson CS (1998) Comparison of brain tissue oxygen tension to microdialysis-based measures of cerebral ischemia in fatally head-injured humans. J Neurotrauma 15(7):509–519

    Article  CAS  PubMed  Google Scholar 

  33. Vespa PM (2006) The implications of cerebral ischemia and metabolic dysfunction for treatment strategies in neurointensive care. Curr Opin Crit Care 12:119–123

    Article  PubMed  Google Scholar 

  34. Vespa P, Bergsneider M, Hattori N et al (2005) Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study. J Cereb Blood Flow Metab 25:763–774

    Article  CAS  PubMed  Google Scholar 

  35. Vespa P, Prins M, Ronne-Engstrom E, Caron M, Shalmon E, Hovda DA et al (1998) Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg 89:971–982

    Article  CAS  PubMed  Google Scholar 

  36. Zielke HR, Zielke CL, Baab PJ (2009) Direct measurement of oxidative metabolism in the living brain by microdialysis: a review. J Neurochem 109(Suppl 1):24–29

    Article  CAS  PubMed  Google Scholar 

  37. Zwienenberg M, Muizelaar JP (1999) Severe pediatric head injury: the role of hyperemia revisited. Neurotrauma 16:937–943

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Spyros Sgouros.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Charalambides, C., Sgouros, S. & Sakas, D. Intracerebral microdialysis in children. Childs Nerv Syst 26, 215–220 (2010). https://doi.org/10.1007/s00381-009-1031-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-009-1031-3

Keywords

Navigation