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Influence of gravity for optimal head positions in the treatment of head injury patients

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Abstract

Background

Brain edema is a major neurological complication of traumatic brain injury (TBI), commonly including a pathologically increased intracranial pressure (ICP) associated with poor outcome. In this study, gravitational force is suggested to have a significant impact on the pressure of the edema zone in the brain tissue and the objective of the study was to investigate the significance of head position on edema at the posterior part of the brain using a finite element (FE) model.

Methods

A detailed FE model including the meninges, brain tissue and a fully connected cerebrospinal fluid (CSF) system was used in this study. Brain tissue was modelled as a poroelastic material consisting of an elastic solid skeleton composed of neurons and neuroglia, permeated by interstitial fluid. The effect of head positions (supine and prone position) due to gravity was investigated for a localized brain edema at the posterior part of the brain.

Results

The water content increment at the edema zone remained nearly identical for both positions. However, the interstitial fluid pressure (IFP) inside the edema zone decreased around 15% by having the head in a prone position compared with a supine position.

Conclusions

The decrease of IFP inside the edema zone by changing patient position from supine to prone has the potential to alleviate the damage to central nervous system nerves. These observations indicate that considering the patient’s head position during intensive care and at rehabilitation might be of importance to the treatment of edematous regions in TBI patients.

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Acknowledgments

We are grateful for the technical support from Comsol support on the implementation of poroelastisity in the software. We would like to acknowledge financial support provided by the Swedish Research Council D.nr. 621-2008-3400, and the Chinese Council Scholarship (CSC) for the first author.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of Neuronic Engineering, KTH—Royal Institute of Technology, Alfred Nobels Allé 10, 141 52, Huddinge, Sweden

    Xiaogai Li, Hans von Holst & Svein Kleiven

  2. Department of Clinical Neuroscience, Section of Neurosurgery, Karolinska Institute, Stockholm, Sweden

    Hans von Holst

Authors
  1. Xiaogai Li
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  2. Hans von Holst
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  3. Svein Kleiven
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Corresponding author

Correspondence to Xiaogai Li.

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Comment

In this interesting study, the Authors hypothesize the influence of the changing position from supine to prone on the intracranial pressure. This topic is of very high significance in neurosurgical ICU and can introduce some changes in the current standards of care. Moreover, some patients with polytrauma need sometimes a rotational bed therapy to treat pulmonary failures, which was until now considered unfavorable in the injured brain. The Authors should be complimented for providing an innovative and unconventional investigation with an outstanding and simple implication in the clinic.

Alex Alfieri,

Christian Marquart,

Gershom Koman,

Halle (Saale), Germany

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Li, X., von Holst, H. & Kleiven, S. Influence of gravity for optimal head positions in the treatment of head injury patients. Acta Neurochir 153, 2057–2064 (2011). https://doi.org/10.1007/s00701-011-1078-2

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  • DOI: https://doi.org/10.1007/s00701-011-1078-2

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