Skip to main content
Erschienen in: Child's Nervous System 2/2010

01.02.2010 | Focus Session

Intracerebral microdialysis in children

verfasst von: Constantinos Charalambides, Spyros Sgouros, Damianos Sakas

Erschienen in: Child's Nervous System | Ausgabe 2/2010

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Cerebral microdialysis is a relatively new, minimally invasive technique that permits sampling and analyzing the chemical constituents of the extracellular fluid. Although mainly used as a research tool, it is also used in the neurointensive care, in combination with other monitoring methods, in patients with severe traumatic brain injury and subarachnoid hemorrhage. Its main clinical utility is the identification of markers of ischemia and cell damage with the ultimate goal of preventing any secondary insults to the brain by instituting early appropriate treatment measures. With few exceptions, all the available data on intracerebral microdialysis in humans comes from studies performed in adults.

Objective

The purpose of this report is to provide a brief review of the intracerebral microdialysis studies performed in children.

Conclusion

Differences in trends of concentrations of structural and excitatory amino acids have been identified in children, in comparison to those observed in adults, the significance of which remains unknown at present.
Literatur
2.
Zurück zum Zitat Adelson PD, Bratton SL, Carney NA, Chestnut RM, Du Coudray HEM, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents. Pediatr Crit Care Med 4:S1–S71CrossRef Adelson PD, Bratton SL, Carney NA, Chestnut RM, Du Coudray HEM, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents. Pediatr Crit Care Med 4:S1–S71CrossRef
3.
Zurück zum Zitat Ahlsson F, Gedeborg R, Hesselager G, Tuvemo T, Enblad P (2004) Treatment of extreme hyperglycemia monitored with intracerebral microdialysis. Pediatr Crit Care Med 5(1):89–92CrossRefPubMed Ahlsson F, Gedeborg R, Hesselager G, Tuvemo T, Enblad P (2004) Treatment of extreme hyperglycemia monitored with intracerebral microdialysis. Pediatr Crit Care Med 5(1):89–92CrossRefPubMed
4.
Zurück zum Zitat Alessandri B, Doppenberg E, Bullock R, Woodward J, Choi S, Koura S, Young HF (1999) Glucose and lactate metabolism after severe human head injury: influence of excitatory neurotransmitters and injury type. Acta Neurochir Suppl 75:21–24PubMed Alessandri B, Doppenberg E, Bullock R, Woodward J, Choi S, Koura S, Young HF (1999) Glucose and lactate metabolism after severe human head injury: influence of excitatory neurotransmitters and injury type. Acta Neurochir Suppl 75:21–24PubMed
5.
Zurück zum Zitat Bellander BM, Cantais E, Enblad P, Hutchinson P, Nordstrom CH, Robertson C, Sahuquillo J, Smith M, Stocchetti N, Ungerstedt U, Unterberg A, Olsen NV (2004) Consensus meeting on microdialysis in neurointensive care. Int Care Med 30:2166–2169CrossRef Bellander BM, Cantais E, Enblad P, Hutchinson P, Nordstrom CH, Robertson C, Sahuquillo J, Smith M, Stocchetti N, Ungerstedt U, Unterberg A, Olsen NV (2004) Consensus meeting on microdialysis in neurointensive care. Int Care Med 30:2166–2169CrossRef
6.
Zurück zum Zitat Bullock R, Zauner A, Woodward JJ, Myseros J, Choi SC, Ward JD et al (1998) Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg 89:507–518CrossRefPubMed Bullock R, Zauner A, Woodward JJ, Myseros J, Choi SC, Ward JD et al (1998) Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg 89:507–518CrossRefPubMed
7.
Zurück zum Zitat Clausen T, Alves OL, Reinert M et al (2005) Association between elevated brain tissue glycerol levels and poor outcome following severe traumatic brain injury. J Neurosurg 103:233–238CrossRefPubMed Clausen T, Alves OL, Reinert M et al (2005) Association between elevated brain tissue glycerol levels and poor outcome following severe traumatic brain injury. J Neurosurg 103:233–238CrossRefPubMed
8.
Zurück zum Zitat Duck SC, Wyatt DT (1988) Factors associated with brain herniation in the treatment of diabetic ketoacidosis. J Pediatr 113:10–14CrossRefPubMed Duck SC, Wyatt DT (1988) Factors associated with brain herniation in the treatment of diabetic ketoacidosis. J Pediatr 113:10–14CrossRefPubMed
9.
Zurück zum Zitat Goodman JC, Valadka AB, Gopinath SP, Uzura M, Robertson CS (1999) Extracellular lactate and glucose alterations in the brain after head injury measured by microdialysis. Crit Care Med 27(9):1965–1973CrossRefPubMed Goodman JC, Valadka AB, Gopinath SP, Uzura M, Robertson CS (1999) Extracellular lactate and glucose alterations in the brain after head injury measured by microdialysis. Crit Care Med 27(9):1965–1973CrossRefPubMed
10.
Zurück zum Zitat Hillered L, Persson L (1999) Theory and practice of microdialysis—prospect for future clinical use. Acta Neurochir Suppl 75:3–6PubMed Hillered L, Persson L (1999) Theory and practice of microdialysis—prospect for future clinical use. Acta Neurochir Suppl 75:3–6PubMed
11.
Zurück zum Zitat Hillered L, Persson L, Nilsson P, Ronne-Engstrom E, Enblad P (2006) Continuous monitoring of cerebral metabolism in traumatic brain injury: a focus on cerebral microdialysis. Curr Opin Crit Care 12:112–118CrossRefPubMed Hillered L, Persson L, Nilsson P, Ronne-Engstrom E, Enblad P (2006) Continuous monitoring of cerebral metabolism in traumatic brain injury: a focus on cerebral microdialysis. Curr Opin Crit Care 12:112–118CrossRefPubMed
12.
Zurück zum Zitat Hlatky R, Valadka AB, Goodman JC et al (2004) Patterns of energy substrates during ischemia measured in the brain by microdialysis. J Neurotrauma 21:984–906CrossRef Hlatky R, Valadka AB, Goodman JC et al (2004) Patterns of energy substrates during ischemia measured in the brain by microdialysis. J Neurotrauma 21:984–906CrossRef
13.
Zurück zum Zitat Hutchinson PJA, Al-Rawi PG, O’Connell MT, Gupta AK, Maskell LB, Hutchinson DBA, Pickard JD, Kirkpatrick PJ (2000) On-line monitoring of substrate delivery and brain metabolism in head injury. Acta Neurochir 76:431–435 Hutchinson PJA, Al-Rawi PG, O’Connell MT, Gupta AK, Maskell LB, Hutchinson DBA, Pickard JD, Kirkpatrick PJ (2000) On-line monitoring of substrate delivery and brain metabolism in head injury. Acta Neurochir 76:431–435
14.
Zurück zum Zitat Johnston AJ, Gupta AK (2002) Advanced monitoring in the neurology intensive care unit: microdialysis. Curr Opin Crit Care 8:121–127CrossRefPubMed Johnston AJ, Gupta AK (2002) Advanced monitoring in the neurology intensive care unit: microdialysis. Curr Opin Crit Care 8:121–127CrossRefPubMed
15.
Zurück zum Zitat Mahoney CP, Vlcek BW, DelAguila M (1999) Risk factors for developing brain herniation during diabetic ketoacidosis. Pediatr Neurol 21:721–727CrossRefPubMed Mahoney CP, Vlcek BW, DelAguila M (1999) Risk factors for developing brain herniation during diabetic ketoacidosis. Pediatr Neurol 21:721–727CrossRefPubMed
16.
Zurück zum Zitat Maurer MH, Haux D, Sakowitz OW, Unterberg AW, Kuschinsky W (2007) Identification of early markers for symptomatic vasospasm in human cerebral microdialysate after subarachnoid hemorrhage: preliminary results of a proteome-wide screening. J Cereb Blood Flow Metab 27:1675–1683CrossRefPubMed Maurer MH, Haux D, Sakowitz OW, Unterberg AW, Kuschinsky W (2007) Identification of early markers for symptomatic vasospasm in human cerebral microdialysate after subarachnoid hemorrhage: preliminary results of a proteome-wide screening. J Cereb Blood Flow Metab 27:1675–1683CrossRefPubMed
17.
Zurück zum Zitat Meyerson BA, Linderoth B, Karlsson H et al (1990) Microdialysis in the human brain: extracellular measurements in the thalamus of parkinsonian patients. Life Sci 46:301–308CrossRefPubMed Meyerson BA, Linderoth B, Karlsson H et al (1990) Microdialysis in the human brain: extracellular measurements in the thalamus of parkinsonian patients. Life Sci 46:301–308CrossRefPubMed
18.
Zurück zum Zitat Newcomb R, Pierce AR, Kano T, Meng W, Bosque-Hamilton P, Taylor L et al (1997) Characterization of mitochondrial glutaminase and amino acids at prolonged times after experimental focal cerebral ischemia. Brain Res 813:103–111CrossRef Newcomb R, Pierce AR, Kano T, Meng W, Bosque-Hamilton P, Taylor L et al (1997) Characterization of mitochondrial glutaminase and amino acids at prolonged times after experimental focal cerebral ischemia. Brain Res 813:103–111CrossRef
19.
Zurück zum Zitat Newcomb R, Sun X, Taylor L, Curthoys N, Giffard RG (1997) Increased production of extracellular glutamate by the mitochondrial glutaminase following neuronal death. J Biol Chem 272:11276–11282CrossRefPubMed Newcomb R, Sun X, Taylor L, Curthoys N, Giffard RG (1997) Increased production of extracellular glutamate by the mitochondrial glutaminase following neuronal death. J Biol Chem 272:11276–11282CrossRefPubMed
20.
Zurück zum Zitat Nilsonn OG, Brandt L, Ungerstedt U, Saveland H (1999) Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 45(5):1176–1185CrossRef Nilsonn OG, Brandt L, Ungerstedt U, Saveland H (1999) Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 45(5):1176–1185CrossRef
21.
Zurück zum Zitat Nordstrom CH, Reinstrup P, Xu W, Gardenfors A, Ungerstedt U (2003) Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional energy metabolism. Anesthesiology 98:809–814CrossRefPubMed Nordstrom CH, Reinstrup P, Xu W, Gardenfors A, Ungerstedt U (2003) Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional energy metabolism. Anesthesiology 98:809–814CrossRefPubMed
22.
Zurück zum Zitat Persson L, Valtysson J, Enblad P, Warme PE, Cesarini K, Lewen A, Hillered L (1996) Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid hemorrhage. J Neurosurg 84:606–616CrossRefPubMed Persson L, Valtysson J, Enblad P, Warme PE, Cesarini K, Lewen A, Hillered L (1996) Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid hemorrhage. J Neurosurg 84:606–616CrossRefPubMed
23.
Zurück zum Zitat Rasmussen JS, Schulz M, Kristensen SR, Bjerre P (2004) Delayed neurological deficits detected by an ischemic pattern in the exracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 100:8–15CrossRef Rasmussen JS, Schulz M, Kristensen SR, Bjerre P (2004) Delayed neurological deficits detected by an ischemic pattern in the exracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 100:8–15CrossRef
24.
Zurück zum Zitat Reinstrup P, Stahl N, Mellergard P, Uski T, Ungerstedt U, Nordstrom CH (2000) Intracerebral microdialysis in clinical practice: baseline values for chemical markers during wakefulness, anesthesia and neurosurgery. Neurosurgery 47(3):701–710CrossRefPubMed Reinstrup P, Stahl N, Mellergard P, Uski T, Ungerstedt U, Nordstrom CH (2000) Intracerebral microdialysis in clinical practice: baseline values for chemical markers during wakefulness, anesthesia and neurosurgery. Neurosurgery 47(3):701–710CrossRefPubMed
25.
Zurück zum Zitat Richards AD, Tolias CM, Sgouros S, Bowery NG (2003) Extracellular glutamine to glutamate ratio may predict outcome in the injured brain: a clinical microdialysis study in children. Pharmacol Res 48:101–109PubMed Richards AD, Tolias CM, Sgouros S, Bowery NG (2003) Extracellular glutamine to glutamate ratio may predict outcome in the injured brain: a clinical microdialysis study in children. Pharmacol Res 48:101–109PubMed
26.
Zurück zum Zitat Schlenk F, Graetz D, Nagel A, Schmidt M, Sarrafradeh AS (2008) Insulin-related decrease in cerebral glucose despite normoglycemia in aneurysmal subarachnoid hemorrhage. Critical Care 12(1):R9CrossRefPubMed Schlenk F, Graetz D, Nagel A, Schmidt M, Sarrafradeh AS (2008) Insulin-related decrease in cerebral glucose despite normoglycemia in aneurysmal subarachnoid hemorrhage. Critical Care 12(1):R9CrossRefPubMed
27.
Zurück zum Zitat Schneweis S, Grond M, Staub F, Brinker G, Neveling M, Dohmen C, Graf R, Heiss WD (2001) Predictive value of neurochemical monitoring in large middle cerebral artery infarction. Stroke 32:1863–1867PubMed Schneweis S, Grond M, Staub F, Brinker G, Neveling M, Dohmen C, Graf R, Heiss WD (2001) Predictive value of neurochemical monitoring in large middle cerebral artery infarction. Stroke 32:1863–1867PubMed
28.
Zurück zum Zitat Stahl N, Ungerstedt U, Nordstrom CH (2001) Brain energy metabolism during controlled reduction of cerebral perfusion pressure in severe head injuries. Int Care Med 27:1215–1223CrossRef Stahl N, Ungerstedt U, Nordstrom CH (2001) Brain energy metabolism during controlled reduction of cerebral perfusion pressure in severe head injuries. Int Care Med 27:1215–1223CrossRef
29.
Zurück zum Zitat Tolias CM, Richards CA, Bowery NG, Sgouros S (2002) Extracellular glutamate in the brains of children with severe head injuries: a pilot microdialysis study. Child’s Nerv Syst 18:368–374 Tolias CM, Richards CA, Bowery NG, Sgouros S (2002) Extracellular glutamate in the brains of children with severe head injuries: a pilot microdialysis study. Child’s Nerv Syst 18:368–374
30.
Zurück zum Zitat Ungerstedt U, Rostami E (2004) Microdialysis in neurointensive care. Curr Pharma Des 10:2145–2152CrossRef Ungerstedt U, Rostami E (2004) Microdialysis in neurointensive care. Curr Pharma Des 10:2145–2152CrossRef
31.
Zurück zum Zitat Unterberg AW, Sakowitz OW, Sarrafzadeh AS, Benndorf G, Lanksch WR (2001) Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 94:740–749CrossRefPubMed Unterberg AW, Sakowitz OW, Sarrafzadeh AS, Benndorf G, Lanksch WR (2001) Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 94:740–749CrossRefPubMed
32.
Zurück zum Zitat Valadka AB, Goodman JC, Gopinath SP, Uzura M, Robertson CS (1998) Comparison of brain tissue oxygen tension to microdialysis-based measures of cerebral ischemia in fatally head-injured humans. J Neurotrauma 15(7):509–519CrossRefPubMed Valadka AB, Goodman JC, Gopinath SP, Uzura M, Robertson CS (1998) Comparison of brain tissue oxygen tension to microdialysis-based measures of cerebral ischemia in fatally head-injured humans. J Neurotrauma 15(7):509–519CrossRefPubMed
33.
Zurück zum Zitat Vespa PM (2006) The implications of cerebral ischemia and metabolic dysfunction for treatment strategies in neurointensive care. Curr Opin Crit Care 12:119–123CrossRefPubMed Vespa PM (2006) The implications of cerebral ischemia and metabolic dysfunction for treatment strategies in neurointensive care. Curr Opin Crit Care 12:119–123CrossRefPubMed
34.
Zurück zum Zitat Vespa P, Bergsneider M, Hattori N et al (2005) Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study. J Cereb Blood Flow Metab 25:763–774CrossRefPubMed Vespa P, Bergsneider M, Hattori N et al (2005) Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study. J Cereb Blood Flow Metab 25:763–774CrossRefPubMed
35.
Zurück zum Zitat Vespa P, Prins M, Ronne-Engstrom E, Caron M, Shalmon E, Hovda DA et al (1998) Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg 89:971–982CrossRefPubMed Vespa P, Prins M, Ronne-Engstrom E, Caron M, Shalmon E, Hovda DA et al (1998) Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg 89:971–982CrossRefPubMed
36.
Zurück zum Zitat Zielke HR, Zielke CL, Baab PJ (2009) Direct measurement of oxidative metabolism in the living brain by microdialysis: a review. J Neurochem 109(Suppl 1):24–29CrossRefPubMed Zielke HR, Zielke CL, Baab PJ (2009) Direct measurement of oxidative metabolism in the living brain by microdialysis: a review. J Neurochem 109(Suppl 1):24–29CrossRefPubMed
37.
Zurück zum Zitat Zwienenberg M, Muizelaar JP (1999) Severe pediatric head injury: the role of hyperemia revisited. Neurotrauma 16:937–943CrossRef Zwienenberg M, Muizelaar JP (1999) Severe pediatric head injury: the role of hyperemia revisited. Neurotrauma 16:937–943CrossRef
Metadaten
Titel
Intracerebral microdialysis in children
verfasst von
Constantinos Charalambides
Spyros Sgouros
Damianos Sakas
Publikationsdatum
01.02.2010
Verlag
Springer-Verlag
Erschienen in
Child's Nervous System / Ausgabe 2/2010
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-009-1031-3

Weitere Artikel der Ausgabe 2/2010

Child's Nervous System 2/2010 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.