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Cerebral Critical Closing Pressure in Concomitant Traumatic Brain Injury and Intracranial Hematomas
Kseniia A Trofimova1, Darya I Agarkova2, Alex O Trofimov3,4
1Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
Abstract:
The critical closing pressure (CrCP) is the pressure below which the local pial blood pressure is inadequate to prevent blood flow cessation. The cerebral CrCP in concomitant traumatic brain injury (TBI) and intracranial hematomas (TBI + ICH) remains understudied. The aim was to determine the status of the CrCP at сTBI with and without the ICH development.
Material And Methods:
The results of the treatment of 90 patients with severe to moderate сTBI were studied (male/female - 49:41). The average age was 34.2 ± 14.4 years. Depending on the presence of ICH, patients were divided into two groups. All patients were subjected to transcranial Doppler of the both middle cerebral arteries, and evaluation of mean arterial pressure (MAP). Based on data obtained, the CrCPs were calculated. Significance was preset to p < 0.05.
Results:
The mean CrCP values in each group appeared to be significantly higher than a referral value (р < 0.05). The mean CrCP values in the perifocal zone of removed hematoma were significantly higher than in TBI patients without ICH (р = 0.015 and р = 0.048, respectively). Analysis of CrCP values in various types of ICH showed no statistically significant differences (р > 0.05).
Discussion:
The CrCP significantly differs in the groups of TBI patients with and without ICH. The comparability of the groups in respect to the concomitant injury structure proves that the revealed CrCP changes result from the traumatic compression of the brain.
