Intracranial Pressure V Edited by S. Ishii, H. Nagai, and M. Brock With 338 Figures and 142 Tables Springer-Verlag Berlin Heidelberg New York Tokyo 1983 Shozo Ishii, M. D. Depart~ent of Neurosurgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113, Japan Hajime Nagai, M. D. Department of Neurosurgery, Nagoya City University, Medical School, 1 Kawasumi, Mizuho-ku, Nagoya 467, Japan Prof. Dr. Mario Brock N eurochirurgische Klinik und Poliklinik, Universitatsklinikum Steglitz, Freie Universitat Berlin, Hindenburgdamm 30, D-IOoo Berlin 45, FRG ISBN-13:978-3-642-69206-2 e-ISBN- 13 :978-3-642-69204-8 DOl: 10.1007/978-3-642-69204-8 Library of Congress Cataloging in Publication Data International Symposium on Intracranial Pressure (5th: 1982 : Tokyo, Japan) Intracranial pressure V. "Proceedings of the Fifth International Symposium on Intracranial Pressure held at Tokyo, Japan, May 30 - June 3, 1982" - Prelim. p. Includes bibliographical references and index. 1. Brain-Diseases-Congresses. 2. Intracranial pressure-Congresses. I. Ishii, S. (Shozo), 1923-. II. Nagai, H. (Hajime), 1928-. III. Brock, M. (Mario), 1938-. Iv. Title. V. Title: Intracranial pressure 5. VI. Title: Intracranial pressure five. [DNLM: 1. Intracranial pressure-Congresses. W3IN995) RC 386.156 1982 616.8 83-10338 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to 'Verwertungsgesellschaft Wort', Munich. © Springer Verlag Berlin Heidelberg 1983 Softcover reprint ofthe hardcover I st edition 1983 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protec tive laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereoff contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 212713140-543210 Proceedings of the Fifth International Symposium on Intracranial Pressure Tokyo, Japan, May 30 - June 3, 1982 Organizing Committee Advisory Committee S. Ishii, Tokyo T. W Langfitt, Philadelphia, Secretary Chairman H. Chigasaki, J. W F. Beks, Groningen Tokorozawa, Saitama M. Brock, West-Berlin Prefecture P. Janny, Clermont-Ferrand H. Handa, Kyoto B. Jennett, Glasgow H. Makino, Chiba N. Lundberg, Lund H. Nagai, Nagoya K Sano, Tokyo S. Yamamoto, Kanazawa Preface This volume contains papers presented at the Fifth International Symposium on Intra cranial Pressure held on May 30-June 3,1982, in Tokyo, Japan. The Symposium has continued to grow since it began in 1972, and this year it was comprised 121 oral and 46 poster presentations. This considerable number was chosen from the more than 216 abstracts that were received, which made the selection process very difficult. We would like to thank the Program Committee for their efforts. One hundred and fifty-one of the manuscripts are printed here. The classic papers, short communications, and the presentations for the poster sessions here appear together under their appropriate topic heading. There were eleven sessions which spanned the most basic scientific descriptions of ICP dynamics to the most recent clinical advances and debate. Also included are the seven special seminars given by the invited speakers. These spe cial seminars were an innovation at this symposium as a means of reviewing the major aspects and history and of projecting the future directions of this expanding field. The organizers wish to thank the Advisory Committee for their guidance and focus, and to express their appreciation to everyone who contributed to the success of this meeting - to the Chairmen and Co-chairmen, to all of the members and participants, and not least of all to our executive staff who worked behind the scenes. We also wish to acknowledge our gratitude to Springer-Verlag for their technical aid and for their prompt publication of this volume. Grateful acknowledgement is made of the generous support given by The Japan Ship building Industry Foundation. The Sixth International Symposium on Intracranial Pressure will be held in Scotland in 1985. The Editors VII Table of Contents Special Seminar ICP Revisited M Brock....................................................... 3 Sympathetic Nervous Control of CSF Production in Normal and Hydrocephalic Animals, and Its Relationship to Cerebral Blood Volume and Intracranial Pressure Ch Owman and M Lindvall ......................................... 10 New Trends for the Evaluation of Experimental Brain Edema K.-A. Hossmann ................................................... 29 Significance and Management of Intracranial Hypertension in Head Injury J.D. Miller ....................................................... 44 CT, NMR, and Emission Tomography in the Diagnosis and Management of Brain Swelling and Intracranial Hypertension T. W. Langfitt ..................................................... 54 The Saga of the Monro-Kellie Doctrine N Lundberg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 68 Session A: Methodology Critical Study of the Co planarity. The Dura Mater as Measurement Interface of the Intracranial Pressure (ICP) by the Epidural Method G. Clemente, Y. Lazorthes, B. Aragon, and J. Richard. . . . . . . . . . . . . . . . . . . .. 79 Epidural Intracranial Pressure Monitoring: A New Method A.B. Levin, A.R. Kahn, and D. Bahr ................................... 85 An Indwelling Epidural Pressure Sensor with Integrated Circuits for Biotelemetry M Furuse, M Hasuo, H. Kuchiwaki, A. Ikeyama, H. Inagaki, T. Ishihara, /. Igarashi, and T. Kitano ............................................ 90 ICP Measurement of Hydrostatic Pressure Balance Method Yoriyoshi Kumagai, Yoriaki Kumagai, J. Ikebe, and M Ohta ................ 95 Intracranial Pressure Monitoring by Fiber Optic Technique P. Fasol, R. Schedl, W. Sebek, and M Strickner .......................... 100 IX Experimental and Clinical Experience with a New Solid State Intracranial Pressure Monitor with In Vivo Zero Capability P.A. Roberts, Ch Fullenwider, F.A. Stevens, and M Pollay ................ 104 A Simple Clinical ICP Meter M Numoto, M Hara, H. Yokota, C Kadowaki, T. Maeda, and K. Takeuchi .................................................. 106 Clinical Comparison of Intracranial Pressure Measurements Provided by Subdural Screws and Ventricular Catheters J. O. Rowan, A.D. Mendelow, L. Murray, and A. Kerr ..................... 110 ICP-Monitoring in the Middle Cranial Fossa. A Comparison Between the Intraventricular Method and the Introduction of a Catheter Tip Transducer into the Parasellar Cistern via the Foramen Ovale H.-u. ThaI ...................................................... 116 Characteristics of a New ICP Monitoring Device E.L. McCleary and P.R. Cooper. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 122 Accurate Intracranial Pressure Monitoring CB. Shields, H.D. Garretson, R. Roski, and c.P. McGraw . .............. 124 Chronic Monitoring of Intraventricular Pressure in Children Using Telemetry: Engineering and Physiologic Aspects H.L. Rekate, D. Fleming, A. Leung, W. Ko, and F.E. Nulsen ............... 127 Experiences with a New Telemetric Pressure Meter K. Osaka, T. Maeda, T. Ohta, and L Sakaguchi .......................... 131 Usefulness of ICP Histogram and ICP Histogram Array in ICP Monitoring H. Tsutsumi, H. Nishiyama, T. Aruga, H. Toyooka, K. Mii, M Tsuzuki, S. Manaka, and K. Takakura . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 135 ICP Monitoring Combined with the Spectrum Analysis of EEG H. Takizawa, K. Sugiura, M Baba, T. Chishiki, K. Muraoka, T. Tach~awa,E. Kamathul~,andT.Kasai ............................. 140 Computerized Monitoring of ICP R. Schedl, H. Benzer, P. Fasol, N Mutz, W. Sebek, H. Spangler, and M Strickner ................................................. .145 Prediction of ICP and Pressure Wave Discrimination with Our Intelligent Monitor System (IMNIC-l) T. Ikeda, S. Nakatani, L Hagiwara, K. Nakao, K. Koshino, and H. Mogami ..... 150 Automatic ICP Controller: A New Device K. Iwata, H. Yuasa, T. Sugiyama, and A. Yamazaki ....................... 157 Automated Cerebral Perfusion Pressure Control: A Preliminary Report L Hagiwara and S. Nakatani ......................................... 163 Session B: Pulse Wave CSF-Dynamics: Integration of Pulsatory Components and Autoregulation into a Mathematical Model o. Hoffmann ................................................... 169 x Starling Resistor as a Model of the Cerebrovascular Bed M Chopp and RD. Portnoy............. .... .. ... .. ..... . . .. .. .... 174 CSF Pulse Wave, ICP, and Autoregulation RD. Portnoy, M Chopp, C Branch, and M Shannon. . . . . . . . . . . . . . . . . . .. 180 Computer-Analysis of ICP-Modulations: Clinical Significance and Prediction of ICP-Dynamics A. Brawanski, MR. Gaab, and RE. Heif3ler ............................ 186 The CSF Pulse Pressure as Indicator of Intracranial Elastance: The Role of the Pulsatile Changes in Cerebral Blood Volume J.RM van Eijndhoven and CJ.J. Avezaat .............................. 191 ICP - Some Observations K Loga muthu krishnan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 197 Analysis of the Pulse Waveform of ICP in Cases with Congenital Heart Disease S. Kuramoto, O. Nakashima, T. Shirouzu, N. Todo, and K. Oriyogi ..... " ... 201 Analysis of CSF Pulse Wave of Cats A. Gega, S. Utsumi, Y. Iida, and N. Iida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 206 Conduction Time of the Pulse Through the Brain with Increased Intracranial Pressure M Nitta, Y. Kasuga, Y. Hasegawa, and R Nagai ......................... 211 Changes of Epidural Pulse Waveform in Increased Intracranial Pressure O. Hirai, R Handa, and M Ishikawa .................................. 216 Session C: Pressure-Volume Study New Aspects of Cerebrospinal Fluid Circulation Models with Emphasis on the Stability of the Model Parameters J.RM van Eijndhoven and CJ.J. Avezaat ...................... , ........ 227 An Automated Method of Measurement of Intracranial Mechanical Properties St.R Graham, ME. Miner, D.L. Drennon, and L.E. Hackenberry ............ 234 The Calculation of Brain Elastic Response Parameters in Vivo E.K. Walsh, A. Schettini, and R. Fitzer ................................ 239 The Effects of Cortical Cold Lesion on the Intracranial Pressure-Volume Relationship of Brain Elasticity R.A. Johnston, M Linder, and F.R Sklar .............................. 245 Pressure Volume Changes in Isobaric Brain Impaction A. Marmarou, T. Nakamura, K. Tanaka, and K Shapiro ................... 248 The CSF Volume/Pressure Relationship in Man R Friden and J. Ekstedt ........................................... 252 Pressure-Volume Diagram, Pulse Amplitude and Intracranial Pulse Volume. Analysis and Significance MR Gaab, L Haubitz, A. Brawanski, J. Faulstich, and RE. Heif31er .......... 261 XI Does "Cortisol Ejection" Disturb PSDICP During CPERT Test? 1. Szewczykowski, B. Szukalski, 1. Korsak-Sliwka, E. Taracha, G. Pawlowski, and S. Sliwka . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. 269 ICPjCPP Measurements and Analysis of the Cerebral Elastance Curve with a Microcomputerized System for Neurosurgical Intensive Care R. Urciuoli, G. Lo Russo, R.M Ponzio, and S. Zeme . . . . . . . . . . . . . . . . . . . .. 276 Brain Elastic Parameters and Cerebral Hemodynamics in Hemorrhagic Hypotension A. Schettini and E.K. Walsh.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 282 Comparison of Bolus and Constant Infusion Techniques for Determining the Resistance of the Absorption of CSF K. Shapiro, A. Marmarou, and E. Conway. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 286 The Effect of Craniectomy on the Intracranial Pressure-Volume Relationship and Its Rlevance to the Syndrome of Shunt Dependent Ventricles F.H. Sklar, M Linder, and R.A. Johnston .............................. 291 Session D: ICP Oscillation (Cerebrovascular Aspect) Plateau Wave Etiology J.R. Searle and H. G. Sullivan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 297 The Etiology of Plateau Waves: A Theoretical Model and Experimental Observations M.1. Rosner and D.P. Becker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 301 Oscillating Cerebral Blood Volume: The Origin of B-Waves L Sayama and L.M. Auer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 307 The Role of Intracranial Blood Volume in Mechanical and Pharmacological Decompression M. Taneda, A. Wakayama, K. Ozaki, and K. Yagi .. ...................... 312 Relationship of Cerebral Blood Volume Changes and Estimated Intracranial Compliance L Nyary and J. Vajda .............................................. 316 Compliance-Estimation of Isolated Spinal Fluid Space in Humans J. Vajda and L Nyary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 320 The Conflict Between CSF Pulse Pressure and Volume-Pressure Response During Plateau Waves c.J.J. Avezaat and l.H.M van Eijndhoven ............................. 326 Vasomotor Response in Acute Intracranial Hypertension S. Yamamoto, S. Higashi, H. Fujii, M Hayashi, and H. Ito ................. 333 Importance of Cerebral 02 Extraction Reserve During Elevated Intracranial Pressure in Young Lambs J.E. Backofen, R.C. Koehler, R.J. Traystman, MD. Jones, and MC. Rogers ..................................................... 338 XII Sympathoadrenergic Modulation of Cerebral Blood Volume During Increased ICP L.M. Auer, I. Sayama, B.B. Johansson, and K. Leber. . . . . . . . . . . . . . . . . . . .. 342 Cerebral Venous Circulation Mechanism During Intracranial Hypertension N. Hayashi, T. Tsubokawa, and N. Moriyasu ............................ 348 Possible Mechanism Influencing Decrease of Intracranial Pressure Occurring Following Arousal M. Motomiya, Y. Nakagawa, H. Kinomoto, S. Mabuchi, and M Tsuru ........ 352 ICP Changes During Sleep in Man M Ogashiwa and K. Takeuchi ....................................... 358 Session E: Blood Brain Barrier and Brain Edema Anatomical Studies of Blood Brain Barrier Disruption Following Intracarotid Bile Salt Infusion M.E. Levine, M.K. Spigelman, R.A. Zapulla, 1. T. Povlishock, L.I. Malis, and J.F. Holland. . . . . . . . .. .............................. 367 Aminobenzyl Penicillin Penetration Through Blood-Brain Barrier in Experimental Brain Edema M Yamaguchi and S. Matsumoto .................................... .371 Comparative Reassessment of the Gravimetric and the Drying-Weighing Methods S. Shigeno, T. Shigeno, M Brock, E. Fritschka, and 1. Cervos-Navarro ........ 375 Alterations of Brain Water with Increased Intracranial Pressure 1. Traina and R.O. Dunker ......................................... 380 Intracranial Pressure and Extracellar Bulk Flow in Hyposmolar Edema R. O. Dunker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 Changes of Osmolality of Brain, Cerebrospinal Fluid and Plasma in Acute Cytotoxic Edema in Cats Y. Matsuoka, S. Nishimura,and K.-A. Hossmann ......................... 389 Ischemic Brain Edema: Cytotoxic and Vasogenic Factors T. Shigeno, E. Fritschka, M. Brock,and S. Shigeno ....................... 394 Ischemic Brain Edema and the Glutathione System O. Gotoh, T. Asano, A. Tamura, and K. Takakura . . . . . . . . . . . . . . . . . . . . . .. 399 The Effect of High Intracranial Pressure on Activation and Release of Mediator Compounds in Traumatic Vasogenic Brain Edema A. Baethmann, K. Maier-Hauff, L. Schurer, M Lange, O. Kempski, and A. Unterberg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 405 Electrophysiological and Regional Cerebral Blood Flow Changes Associated with Direct Infusion Edema K. Tanaka, A. Marmarou, and S. Nishimura ............................ 413 XIII