Measurement of brain interstitial fluid pressure in acute head injury patients.

Abstract

We have tried and succeeded in continuous recording of the brain interstitial fluid pressure (BIFP) in 7 acute head injury patients. Pressure gradients were obtained between CSF, non-edematous brain tissue and edematous brain tissue. A higher BIFP was obtained in the lower density edematous area than in the normal density area of the CT scans of the head injury patients, which confirmed the experimental data reported by other investigators. These pressure gradients first became larger and then smaller with propagation of edema into a generalized uncontrollable increased ICP. In cases of severe head injuries in which decompressive craniectomies were performed, initial subcutaneous pressure was low, whereas BIFP deep in the edematous brain tissue was high. From the data obtained, better surgical management of acute head injury patients was inferred by theoretical reasoning. It is concluded that, although intensive medical treatments are being carried out, internal decompression is the choice of surgical policy in the early management of head injury. An external decompression performed prophylactically may induce in some instances intracerebral hemorrhage, intraventricular bleeding, and hydrostatic edema propagation.