Novel method for dynamic control of intracranial pressure

Mark Luciano, Stephen M. Dombrowski, Sara Qvarlander, Serge El-Khoury, Jun Yang, Suraj Thyagaraj, Francis Loth

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Intracranial pressure (ICP) pulsations are generally considered a passive result of the pulsatility of blood flow. Active experimental modification of ICP pulsations would allow investigation of potential active effects on blood and CSF flow and potentially create a new platform for the treatment of acute and chronic low blood flow states as well as a method of CSF substance clearance and delivery. This study presents a novel method and device for altering the ICP waveform via cardiac-gated volume changes. METHODS: The novel device used in this experiment (named Cadence) consists of a small air-filled inelastic balloon (approximately 1.0 ml) implanted into the intracranial space and connected to an external programmable pump, triggered by an R-wave detector. Balloons were implanted into the epidural space above 1 of the hemispheres of 19 canines for up to 10 hours. When activated, the balloons were programed to cyclically infate with the cardiac cycle with variable delay, phase, and volume. The ICP response was measured in both hemispheres. Additionally, cerebral blood flow (heat diffusion and laser Doppler) was studied in 16 canines. RESULTS: This system, depending on the inflation pattern of the balloon, allowed a flattening of the ICP waveform, increase in the ICP waveform amplitude, or phase shift of the wave. This occurred with small mean ICP changes, typically around ± 2 mm Hg (15%). Bilateral ICP effects were observed with activation of the device: balloon inflation at each systole increased the systolic ICP pulse (up to 16 mm Hg, 1200%) and deflation at systole decreased or even inverted the systolic ICP pulse (-0.5 to -19 mm Hg, -5% to -1600%) in a dose-(balloon volume) dependent fashion. No aphysiological or deleterious effects on systemic pressure (≤ ±10 mm Hg; 13% change in mean pressure) or cardiac rate (≤ ± 17 beats per minute; 16% change) were observed during up to 4 hours of balloon activity. CONCLUSIONS: The results of these initial studies using an intracranially implanted, cardiac-gated, volume-oscillating balloon suggest the Cadence device can be used to modify ICP pulsations, without physiologically deleterious effects on mean ICP, systemic vascular effects, or brain injury. This device and technique may be used to study the role of ICP pulsatility in intracranial hemo- and hydrodynamic processes and introduces the creation of a potential platform of a cardiac-gated system for treatment of acute and chronic low blood flow states, and diseases requiring augmentation of CSF substance clearance or delivery.

Original languageEnglish (US)
Pages (from-to)1629-1640
Number of pages12
JournalJournal of Neurosurgery
Volume126
Issue number5
DOIs
StatePublished - May 1 2017

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Intracranial Pressure
Equipment and Supplies
Cardiac Volume
Systole
Economic Inflation
Canidae
Cerebrovascular Circulation
Blood Pressure
Pressure
Epidural Space
Intracranial Hypertension
Vascular System Injuries
Hydrodynamics
Brain Injuries
Lasers
Hot Temperature
Hemodynamics
Air

Keywords

  • Cerebral blood flow
  • Cerebrospinal fluid
  • Diagnostic and operative techniques
  • Implantable device
  • Intracranial pressure
  • Pulsatility

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Luciano, M., Dombrowski, S. M., Qvarlander, S., El-Khoury, S., Yang, J., Thyagaraj, S., & Loth, F. (2017). Novel method for dynamic control of intracranial pressure. Journal of Neurosurgery, 126(5), 1629-1640. https://doi.org/10.3171/2016.4.JNS152457

Novel method for dynamic control of intracranial pressure. / Luciano, Mark; Dombrowski, Stephen M.; Qvarlander, Sara; El-Khoury, Serge; Yang, Jun; Thyagaraj, Suraj; Loth, Francis.

In: Journal of Neurosurgery, Vol. 126, No. 5, 01.05.2017, p. 1629-1640.

Research output: Contribution to journalArticle

Luciano, M, Dombrowski, SM, Qvarlander, S, El-Khoury, S, Yang, J, Thyagaraj, S & Loth, F 2017, 'Novel method for dynamic control of intracranial pressure', Journal of Neurosurgery, vol. 126, no. 5, pp. 1629-1640. https://doi.org/10.3171/2016.4.JNS152457
Luciano M, Dombrowski SM, Qvarlander S, El-Khoury S, Yang J, Thyagaraj S et al. Novel method for dynamic control of intracranial pressure. Journal of Neurosurgery. 2017 May 1;126(5):1629-1640. https://doi.org/10.3171/2016.4.JNS152457
Luciano, Mark ; Dombrowski, Stephen M. ; Qvarlander, Sara ; El-Khoury, Serge ; Yang, Jun ; Thyagaraj, Suraj ; Loth, Francis. / Novel method for dynamic control of intracranial pressure. In: Journal of Neurosurgery. 2017 ; Vol. 126, No. 5. pp. 1629-1640.
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