Cerebrospinal fluid drainage and induced hypertension improve spinal cord perfusion after acute spinal cord injury in pigs

Nikolay L. Martirosyan, M. Yashar S Kalani, William D. Bichard, Ali A. Baaj, L. Fernando Gonzalez, Mark C. Preul, Nicholas Theodore

Research output: Contribution to journalArticle

Abstract

Background: Acute spinal cord injury (SCI) is commonly treated by elevating the mean arterial pressure (MAP). Other potential interventions include cerebrospinal fluid drainage (CSFD). Objective: To determine the efficacy of aggressive MAP elevation combined with intrathecal pressure (ITP) reduction; our primary objective was to improve spinal cord blood flow (SCBF) after SCI. Methods: All 15 pigs underwent laminectomy. Study groups included control (n 3); SCI only (n 3); SCI combined with MAP elevation (SCI + MAP) (n 3); SCI combined with CSFD (SCI + CSFD) (n 3); and SCI combined with both MAP elevation and CSFD (SCI + MAP + CSFD) (n 3). SCBF was measured with laser Doppler flowmetry. Results: In the SCI group, SCBF decreased by 56% after SCI. MAP elevation after SCI resulted in a 34% decrease in SCBF, whereas CSFD resulted in a 59% decrease in SCBF. The combination of CSFD and MAP elevation resulted in a 24% increase in SCBF. The SCI + MAP group had an average ITP increase of 5.45 mm Hg after MAP elevation 1 hour after SCI and remained at that level throughout the experiment. Conclusion: Both MAP elevation alone and CSFD alone led to only short-term improvement of SCBF. The combination of MAP elevation and CSFD significantly and sustainably improved SCBF and spinal cord perfusion pressure. Although laser Doppler flowmetry can provide flow measurements to a tissue depth of only 1.5 mm, these results may represent pattern of blood flow changes in the entire spinal cord after injury.

Original languageEnglish (US)
Pages (from-to)461-468
Number of pages8
JournalNeurosurgery
Volume76
Issue number4
DOIs
StatePublished - Apr 19 2015
Externally publishedYes

Fingerprint

Spinal Cord Injuries
Spinal Cord
Swine
Perfusion
Hypertension
Arterial Pressure
Fetal Blood
Laser-Doppler Flowmetry
Cerebrospinal Fluid Leak
Pressure
Laminectomy

Keywords

  • Cerebrospinal fluid drainage
  • Intrathecal pressure
  • Mean arterial pressure
  • Paraplegia
  • Spinal cord blood flow
  • Spinal cord injury
  • Spinal cord perfusion

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Martirosyan, N. L., Kalani, M. Y. S., Bichard, W. D., Baaj, A. A., Fernando Gonzalez, L., Preul, M. C., & Theodore, N. (2015). Cerebrospinal fluid drainage and induced hypertension improve spinal cord perfusion after acute spinal cord injury in pigs. Neurosurgery, 76(4), 461-468. https://doi.org/10.1227/NEU.0000000000000638

Cerebrospinal fluid drainage and induced hypertension improve spinal cord perfusion after acute spinal cord injury in pigs. / Martirosyan, Nikolay L.; Kalani, M. Yashar S; Bichard, William D.; Baaj, Ali A.; Fernando Gonzalez, L.; Preul, Mark C.; Theodore, Nicholas.

In: Neurosurgery, Vol. 76, No. 4, 19.04.2015, p. 461-468.

Research output: Contribution to journalArticle

Martirosyan, Nikolay L. ; Kalani, M. Yashar S ; Bichard, William D. ; Baaj, Ali A. ; Fernando Gonzalez, L. ; Preul, Mark C. ; Theodore, Nicholas. / Cerebrospinal fluid drainage and induced hypertension improve spinal cord perfusion after acute spinal cord injury in pigs. In: Neurosurgery. 2015 ; Vol. 76, No. 4. pp. 461-468.
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AU - Martirosyan, Nikolay L.

AU - Kalani, M. Yashar S

AU - Bichard, William D.

AU - Baaj, Ali A.

AU - Fernando Gonzalez, L.

AU - Preul, Mark C.

AU - Theodore, Nicholas

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AB - Background: Acute spinal cord injury (SCI) is commonly treated by elevating the mean arterial pressure (MAP). Other potential interventions include cerebrospinal fluid drainage (CSFD). Objective: To determine the efficacy of aggressive MAP elevation combined with intrathecal pressure (ITP) reduction; our primary objective was to improve spinal cord blood flow (SCBF) after SCI. Methods: All 15 pigs underwent laminectomy. Study groups included control (n 3); SCI only (n 3); SCI combined with MAP elevation (SCI + MAP) (n 3); SCI combined with CSFD (SCI + CSFD) (n 3); and SCI combined with both MAP elevation and CSFD (SCI + MAP + CSFD) (n 3). SCBF was measured with laser Doppler flowmetry. Results: In the SCI group, SCBF decreased by 56% after SCI. MAP elevation after SCI resulted in a 34% decrease in SCBF, whereas CSFD resulted in a 59% decrease in SCBF. The combination of CSFD and MAP elevation resulted in a 24% increase in SCBF. The SCI + MAP group had an average ITP increase of 5.45 mm Hg after MAP elevation 1 hour after SCI and remained at that level throughout the experiment. Conclusion: Both MAP elevation alone and CSFD alone led to only short-term improvement of SCBF. The combination of MAP elevation and CSFD significantly and sustainably improved SCBF and spinal cord perfusion pressure. Although laser Doppler flowmetry can provide flow measurements to a tissue depth of only 1.5 mm, these results may represent pattern of blood flow changes in the entire spinal cord after injury.

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