Clinical Use of Cerebral Microdialysis in Patients with Aneurysmal Subarachnoid Hemorrhage-State of the Art.

Raimund Helbok,Bettina Pfausler,Verena Rass,Mario Kofler,Alois Josef Schiefecker,Maxime Gaasch,Ronny Beer,Erich Schmutzhard

doi:10.3389/fneur.2017.00565

Abstract

To review the published literature on the clinical application of cerebral microdialysis (CMD) in aneurysmal subarachnoid hemorrhage (SAH) patients and to summarize the evidence relating cerebral metabolism to pathophysiology, secondary brain injury, and outcome. Study selection: Two reviewers identified all manuscripts reporting on the clinical use of CMD in aneurysmal SAH patients from MEDLINE. All identified studies were grouped according to their focus on brain metabolic changes during the early and subacute phase after SAH, their association with mechanisms of secondary brain injury and outcome. The review demonstrated: (1) limited literature is available in the very early phase before the aneurysm is secured. (2) Brain metabolic changes related to early and delayed secondary injury mechanisms may be used in addition to other neuromonitoring parameters in the critical care management of SAH patients. (3) CMD markers of ischemia may detect delayed cerebral ischemia early (up to 16 h before onset), underlining the importance of trend analysis. (4) Various CMD-derived parameters may be associated with patient outcome at 3-12 months, including CMD-lactate-to-pyruvate-ratio, CMD-glucose, and CMD-glutamate. The clinical use of CMD is an emerging area in the literature of aneurysmal SAH patients. Larger prospective multi-center studies on interventions based on CMD findings are needed.

Highlights

First reports on monitoring of brain metabolism using cerebral microdialysis (CMD) in patients with subarachnoid hemorrhage (SAH) date back to the year 1992 (1)
Cerebral microdialysis is used in the clinical management of severe SAH together with intracranial pressure (ICP), PbtO2, and other neuromonitoring parameters
RH was involved in the idea, design, data acquisition, article selection, writing, interpretation of data, and final revision of the manuscript

Summary

Introduction

First reports on monitoring of brain metabolism using cerebral microdialysis (CMD) in patients with subarachnoid hemorrhage (SAH) date back to the year 1992 (1). Cerebral microdialysis has improved our understanding of pathophysiological mechanisms of early and delayed brain injury in SAH patients by providing metabolic information derived from brain tissue on a cellular level, in addition to intracranial pressure (ICP), cerebral perfusion pressure (CPP), cerebral blood flow (CBF), brain tissue oxygen tension (PbtO2), and electrographic. CMD in SAH Patients monitoring (electroencephalography and electrocorticography). Changes in brain metabolism have been associated with known complications after SAH and may help to detect impending secondary brain injury early or before they have evolved into irreversibility. The effect of commonly applied pharmacological and non-pharmacological treatments on brain metabolism can be studied on an individual level, thereby enhancing the concept of personalized medicine in neurocritical care patients

Methods

Results

Discussion

Conclusion