Direct observation during surgery shows preservation of cerebral microcirculation in patients with traumatic brain injury

Jon Pérez-Bárcena, Eduardo Romay, Juan Antonio Llompart-Pou, Javier Ibáñez, Marta Brell, Pedro Llinás, Elsa González, Amedeo Merenda, Can Ince, Ross Bullock

Research output: Contribution to journalArticle

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Abstract

Objective To describe the alterations of the cortical microcirculation of the brain (blood flow and vessel density) in TBI patients who and compare them with a control group. Methods Prospective and observational study in a third-level university hospital. Cortical microcirculation in the brain was directly observed using sidestream dark-field (SDF) imaging in 14 patients who underwent surgery: 5 subdural hematomas (SDH) and 9 parenchymal lesions (contusions/hematomas). In this last set of patients, images were recorded in the "pericontusional" areas and in the "surrounding" brain (areas that were as far from the lesion as the craniotomy allowed). These patients were compared to five patients who underwent craniotomy for a disease that did not affect the cortex. Results There were fewer "pericontusional" images that could be analyzed due to the presence of subarachnoid hemorrhage. The proportion or perfused vessels was similar in all groups: control 99.5% ± 1.3%; SDH 98.6% ± 2.4%; "pericontusional" area 98.2% ± 2.4%; "surrounding" area 98.4% ± 2.5% (p = 0.145). The perfused vessel density index was smaller in the "pericontusional" area: control 6.5 ± 1.6 l/mm; SDH 6.5 ± 2.5 l/mm; "pericontusional" area 5.4 ± 2.6 l/mm; "surrounding" 6.6 ± 2.1 l/mm (p = 0.07). Conclusions Although the analysis of pericontusional zone was difficult, there were fewer vessels than in the controls and there was no change in the flow. In the surrounding zone and in patients with SDH, we did not document alterations in the microcirculation. Direct imaging of cerebral microcirculation in TBI patients showed that despite serious brain injury the cerebral microcirculation was remarkably well preserved.

Original languageEnglish (US)
Pages (from-to)38-43
Number of pages6
JournalJournal of the Neurological Sciences
Volume353
Issue number1-2
DOIs
StatePublished - Jun 15 2015

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Microcirculation
Observation
Subdural Hematoma
Craniotomy
Brain
Control Groups
Contusions
Subarachnoid Hemorrhage
Traumatic Brain Injury
Hematoma
Brain Injuries
Observational Studies
Blood Vessels
Prospective Studies

Keywords

  • Brain contusion
  • Microcirculation
  • Pericontusional penumbra
  • SDF imaging
  • Subdural hematoma
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Pérez-Bárcena, J., Romay, E., Llompart-Pou, J. A., Ibáñez, J., Brell, M., Llinás, P., ... Bullock, R. (2015). Direct observation during surgery shows preservation of cerebral microcirculation in patients with traumatic brain injury. Journal of the Neurological Sciences, 353(1-2), 38-43. https://doi.org/10.1016/j.jns.2015.03.044

Direct observation during surgery shows preservation of cerebral microcirculation in patients with traumatic brain injury. / Pérez-Bárcena, Jon; Romay, Eduardo; Llompart-Pou, Juan Antonio; Ibáñez, Javier; Brell, Marta; Llinás, Pedro; González, Elsa; Merenda, Amedeo; Ince, Can; Bullock, Ross.

In: Journal of the Neurological Sciences, Vol. 353, No. 1-2, 15.06.2015, p. 38-43.

Research output: Contribution to journalArticle

Pérez-Bárcena, J, Romay, E, Llompart-Pou, JA, Ibáñez, J, Brell, M, Llinás, P, González, E, Merenda, A, Ince, C & Bullock, R 2015, 'Direct observation during surgery shows preservation of cerebral microcirculation in patients with traumatic brain injury', Journal of the Neurological Sciences, vol. 353, no. 1-2, pp. 38-43. https://doi.org/10.1016/j.jns.2015.03.044
Pérez-Bárcena, Jon ; Romay, Eduardo ; Llompart-Pou, Juan Antonio ; Ibáñez, Javier ; Brell, Marta ; Llinás, Pedro ; González, Elsa ; Merenda, Amedeo ; Ince, Can ; Bullock, Ross. / Direct observation during surgery shows preservation of cerebral microcirculation in patients with traumatic brain injury. In: Journal of the Neurological Sciences. 2015 ; Vol. 353, No. 1-2. pp. 38-43.
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AU - Romay, Eduardo

AU - Llompart-Pou, Juan Antonio

AU - Ibáñez, Javier

AU - Brell, Marta

AU - Llinás, Pedro

AU - González, Elsa

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N2 - Objective To describe the alterations of the cortical microcirculation of the brain (blood flow and vessel density) in TBI patients who and compare them with a control group. Methods Prospective and observational study in a third-level university hospital. Cortical microcirculation in the brain was directly observed using sidestream dark-field (SDF) imaging in 14 patients who underwent surgery: 5 subdural hematomas (SDH) and 9 parenchymal lesions (contusions/hematomas). In this last set of patients, images were recorded in the "pericontusional" areas and in the "surrounding" brain (areas that were as far from the lesion as the craniotomy allowed). These patients were compared to five patients who underwent craniotomy for a disease that did not affect the cortex. Results There were fewer "pericontusional" images that could be analyzed due to the presence of subarachnoid hemorrhage. The proportion or perfused vessels was similar in all groups: control 99.5% ± 1.3%; SDH 98.6% ± 2.4%; "pericontusional" area 98.2% ± 2.4%; "surrounding" area 98.4% ± 2.5% (p = 0.145). The perfused vessel density index was smaller in the "pericontusional" area: control 6.5 ± 1.6 l/mm; SDH 6.5 ± 2.5 l/mm; "pericontusional" area 5.4 ± 2.6 l/mm; "surrounding" 6.6 ± 2.1 l/mm (p = 0.07). Conclusions Although the analysis of pericontusional zone was difficult, there were fewer vessels than in the controls and there was no change in the flow. In the surrounding zone and in patients with SDH, we did not document alterations in the microcirculation. Direct imaging of cerebral microcirculation in TBI patients showed that despite serious brain injury the cerebral microcirculation was remarkably well preserved.

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KW - Pericontusional penumbra

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KW - Traumatic brain injury

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