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At this point, there is sufficient energy available to keep the neurons alive, but neuronal work is abolished.

Such reductions in CBF are in the lethal range and result in infarction immediately, if not corrected. These metabolic consequenses of reduced CBF are the same for any mode of flow reduction. However, the indirect monitoring methods do not provide an evaluation of the CBF that is sufficiently sensitive or specific. Only three techniques are more or less suited as bedside CBF monitors.

These include two indirect methods, the transcranial Doppler TCD and the measurement of the arteriovenous oxygen difference AVDO 2 via the jugular bulb catheter and one direct method, the inhalation or intravenous Xe method. The Xe clearance technique for measuring CBF has been used longer and more extensively for the study of patients with craniocerebral trauma and subarachnoid haemorrhage than any other CBF monitoring technique.

Several other promising techniques are not discussed here because they are not clinically relevant or are still in an experimental stage e.


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The vision of optimal neurological monitoring determining regional blood flow and various metabolic parameters, online positron emission tomography PET , is still far in the future. In the meantime, the hydrogen clearance technique has proved to be highly beneficial in the ICU [4] and the operating room [5]. The focus on these techniques does not imply that other CBF methods have no role in the management of neurosurgical patients.

The choice of a CBF measurement technique depends on many considerations: local availability of equipment and expertise, cost, subject human vs. For a comprehensive overview of the CBF techniques available for the moment most neuro-anaesthesia textbooks can be recommended. Often one chapter is dedicated to the enumeration of the advantages and disadvantages of each technique.

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Back to Top Article Outline. Cerebral blood flow measurement in neurosurgical intensive care. Neurosurg Clin N Am, ; 5: Pages Reinhart Murr, S. Berger, L. Kempski, F. Staub, A. Marmarou, K. Bandoh, M. Yoshihara, O. Carter, M. Weinand, K.


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Maas, W. Fleckenstein, D.

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Monitoring Cerebral Blood Flow in Neurosurgical Intensive Care

Meixensberger, J. Dings, H. Kuhnigk, K.

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Haberl, A. Villringer, U. Elwell, H. Owen-Reece, M. Cope, J.

Monitoring Cerebral Blood Flow in Neurosurgical Intensive Care - touchNEUROLOGY

Wyatt, A. Edwards, D. Delpy et al. Chan, N. Dearden, J.

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Cerebral Oxygenation. Schneider, A. Unterberg, W. Helden, R. Franke, W.