Svetlana Trofimova1, Alex Trofimov2, Antony Dubrovin1, Darya Agarkova1, Ksenia Trofimova1, Michael Dobrzeniecki1, Ann Zorkova1, Denis E Bragin3,4. 1. Department of Neurosurgery, Privolzhsky Research Medical University, Nizhniy Novgorod, Russia. 2. Department of Neurosurgery, Privolzhsky Research Medical University, Nizhniy Novgorod, Russia. alexeytrofimov1975@mail.ru. 3. Lovelace Biomedical Research Institute, Albuquerque, NM, USA. 4. Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Abstract
INTRODUCTION: The knowledge of conservative treatment modalities for a chronic subdural hematoma (CSDH) is still based on low-grade evidence. The purpose of this study was to evaluate the condition of the microcirculation and autoregulation in the perifocal CSDH zone for understanding of the mechanism of CSDH development. METHODS: Cerebral microcirculation was evaluated in patients with the aid of brain perfusion computed tomography (PCT) within the first day. Perfusion parameters were assessed quantitatively in the cortex zone adjacent to the CSDH and in a similar zone of the contralateral hemisphere. The same PCT data were assessed quantitatively without and with use of a perfusion calculation mode excluding large-vessel voxels ("remote vessels" (RVs)) in the first and second methods, respectively. RESULTS: The first method of analysis of a similar zone in the contralateral hemisphere revealed significant increases in cerebral blood volume and cerebral blood flow (P < 0.01) in comparison with normal values. Use of the second method with RVs showed no significant changes in perfusion parameters in microcirculatory blood flow in the cortex on the side contralateral to the hematoma. CONCLUSION: The persistence of microcirculatory blood flow perfusion reflects preservation of cerebral blood flow autoregulation in patients with a CSDH.
INTRODUCTION: The knowledge of conservative treatment modalities for a chronic subdural hematoma (CSDH) is still based on low-grade evidence. The purpose of this study was to evaluate the condition of the microcirculation and autoregulation in the perifocal CSDH zone for understanding of the mechanism of CSDH development. METHODS: Cerebral microcirculation was evaluated in patients with the aid of brain perfusion computed tomography (PCT) within the first day. Perfusion parameters were assessed quantitatively in the cortex zone adjacent to the CSDH and in a similar zone of the contralateral hemisphere. The same PCT data were assessed quantitatively without and with use of a perfusion calculation mode excluding large-vessel voxels ("remote vessels" (RVs)) in the first and second methods, respectively. RESULTS: The first method of analysis of a similar zone in the contralateral hemisphere revealed significant increases in cerebral blood volume and cerebral blood flow (P < 0.01) in comparison with normal values. Use of the second method with RVs showed no significant changes in perfusion parameters in microcirculatory blood flow in the cortex on the side contralateral to the hematoma. CONCLUSION: The persistence of microcirculatory blood flow perfusion reflects preservation of cerebral blood flow autoregulation in patients with a CSDH.
Authors: Bruce C V Campbell; Søren Christensen; Christopher R Levi; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis; Mark W Parsons Journal: Stroke Date: 2011-10-06 Impact factor: 7.914
Authors: A Bivard; C Levi; V Krishnamurthy; J Hislop-Jambrich; P Salazar; B Jackson; S Davis; M Parsons Journal: J Neuroradiol Date: 2014-01-13 Impact factor: 3.447