Neuromonitoring bei erhöhtem intrakraniellen Druck

Zusammenfassung

Das Ausmaß des sekundären Hirnschadens, der nach einer akuten Erkrankung des Gehirns auftritt, ist wesentlich für das klinische Ergebnis verantwortlich. Die Methoden des erweiterten Neuromonitorings bieten die Möglichkeit der frühzeitigen Erkennung von derartigen sekundären hypoxischen und ischämischen Ereignissen. Ergänzend zur kontinuierlichen Erfassung des intrakraniellen Drucks bieten die Bulbus-jugularis-Oxymetrie, die Messung des Sauerstoffpartialdrucks im Hirngewebe und die Nah-Infrarot-Spektroskopie Informationen über die zerebrale Oxygenation. Die zerebrale Mikrodialyse erlaubt Einblicke in den Hirnstoffwechsel. Wir möchten einen Überblick über die gängigen Techniken des erweiterten Neuromonitorings geben und deren diagnostischen und therapeutischen Nutzen besprechen.

Abstract

Secondary neuronal damage caused by cerebral hypoxia and ischemia following acute brain disease is a major determinant of patient outcome. Advanced neuromonitoring allows early detection of such insults. In addition to continuous intracranial pressure monitoring, methdods such as jugular bulb oximetry, partial brain tissue oxygen pressure, and near-infrared spectroscopy provide information regarding cerebral oxygenation. Cerebral microdialysis gives insight into brain metabolism. Here, we summarise the currently available techniques in advanced neuromonitoring and discuss their diagnostic and therapeutic value.

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