Table Of ContentIntracranial
Pressure V
Edited by
S. Ishii, H. Nagai, and M. Brock
With 338 Figures and 142 Tables
Springer-Verlag
Berlin Heidelberg New York Tokyo 1983
Shozo Ishii, M. D.
Depart~ent of Neurosurgery, Juntendo University School of
Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113, Japan
Hajime Nagai, M. D.
Department of Neurosurgery, Nagoya City University, Medical School,
1 Kawasumi, Mizuho-ku, Nagoya 467, Japan
Prof. Dr. Mario Brock
N eurochirurgische Klinik und Poliklinik,
Universitatsklinikum Steglitz, Freie Universitat Berlin,
Hindenburgdamm 30, D-IOoo Berlin 45, FRG
ISBN-13:978-3-642-69206-2 e-ISBN- 13 :978-3-642-69204-8
DOl: 10.1007/978-3-642-69204-8
Library of Congress Cataloging in Publication Data
International Symposium on Intracranial Pressure (5th: 1982 : Tokyo, Japan) Intracranial
pressure V. "Proceedings of the Fifth International Symposium on Intracranial Pressure
held at Tokyo, Japan, May 30 - June 3, 1982" - Prelim. p.
Includes bibliographical references and index.
1. Brain-Diseases-Congresses. 2. Intracranial pressure-Congresses. I. Ishii, S. (Shozo), 1923-.
II. Nagai, H. (Hajime), 1928-. III. Brock, M. (Mario), 1938-. Iv. Title. V. Title: Intracranial
pressure 5. VI. Title: Intracranial pressure five. [DNLM: 1. Intracranial pressure-Congresses.
W3IN995) RC 386.156 1982 616.8 83-10338
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212713140-543210
Proceedings of the Fifth International Symposium
on Intracranial Pressure
Tokyo, Japan, May 30 - June 3, 1982
Organizing Committee Advisory Committee
S. Ishii, Tokyo T. W Langfitt, Philadelphia,
Secretary Chairman
H. Chigasaki, J. W F. Beks, Groningen
Tokorozawa, Saitama M. Brock, West-Berlin
Prefecture P. Janny, Clermont-Ferrand
H. Handa, Kyoto B. Jennett, Glasgow
H. Makino, Chiba N. Lundberg, Lund
H. Nagai, Nagoya
K Sano, Tokyo
S. Yamamoto, Kanazawa
Preface
This volume contains papers presented at the Fifth International Symposium on Intra
cranial Pressure held on May 30-June 3,1982, in Tokyo, Japan. The Symposium has
continued to grow since it began in 1972, and this year it was comprised 121 oral and 46
poster presentations. This considerable number was chosen from the more than 216
abstracts that were received, which made the selection process very difficult. We would
like to thank the Program Committee for their efforts. One hundred and fifty-one of
the manuscripts are printed here.
The classic papers, short communications, and the presentations for the poster sessions
here appear together under their appropriate topic heading. There were eleven sessions
which spanned the most basic scientific descriptions of ICP dynamics to the most recent
clinical advances and debate.
Also included are the seven special seminars given by the invited speakers. These spe
cial seminars were an innovation at this symposium as a means of reviewing the major
aspects and history and of projecting the future directions of this expanding field.
The organizers wish to thank the Advisory Committee for their guidance and focus,
and to express their appreciation to everyone who contributed to the success of this
meeting - to the Chairmen and Co-chairmen, to all of the members and participants,
and not least of all to our executive staff who worked behind the scenes. We also wish
to acknowledge our gratitude to Springer-Verlag for their technical aid and for their
prompt publication of this volume.
Grateful acknowledgement is made of the generous support given by The Japan Ship
building Industry Foundation.
The Sixth International Symposium on Intracranial Pressure will be held in Scotland
in 1985.
The Editors
VII
Table of Contents
Special Seminar
ICP Revisited
M Brock....................................................... 3
Sympathetic Nervous Control of CSF Production in Normal and Hydrocephalic
Animals, and Its Relationship to Cerebral Blood Volume and Intracranial Pressure
Ch Owman and M Lindvall ......................................... 10
New Trends for the Evaluation of Experimental Brain Edema
K.-A. Hossmann ................................................... 29
Significance and Management of Intracranial Hypertension in Head Injury
J.D. Miller ....................................................... 44
CT, NMR, and Emission Tomography in the Diagnosis and Management of
Brain Swelling and Intracranial Hypertension
T. W. Langfitt ..................................................... 54
The Saga of the Monro-Kellie Doctrine
N Lundberg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 68
Session A: Methodology
Critical Study of the Co planarity. The Dura Mater as Measurement Interface of
the Intracranial Pressure (ICP) by the Epidural Method
G. Clemente, Y. Lazorthes, B. Aragon, and J. Richard. . . . . . . . . . . . . . . . . . . .. 79
Epidural Intracranial Pressure Monitoring: A New Method
A.B. Levin, A.R. Kahn, and D. Bahr ................................... 85
An Indwelling Epidural Pressure Sensor with Integrated Circuits for Biotelemetry
M Furuse, M Hasuo, H. Kuchiwaki, A. Ikeyama, H. Inagaki, T. Ishihara,
/. Igarashi, and T. Kitano ............................................ 90
ICP Measurement of Hydrostatic Pressure Balance Method
Yoriyoshi Kumagai, Yoriaki Kumagai, J. Ikebe, and M Ohta ................ 95
Intracranial Pressure Monitoring by Fiber Optic Technique
P. Fasol, R. Schedl, W. Sebek, and M Strickner .......................... 100
IX
Experimental and Clinical Experience with a New Solid State Intracranial
Pressure Monitor with In Vivo Zero Capability
P.A. Roberts, Ch Fullenwider, F.A. Stevens, and M Pollay ................ 104
A Simple Clinical ICP Meter
M Numoto, M Hara, H. Yokota, C Kadowaki, T. Maeda,
and K. Takeuchi .................................................. 106
Clinical Comparison of Intracranial Pressure Measurements Provided
by Subdural Screws and Ventricular Catheters
J. O. Rowan, A.D. Mendelow, L. Murray, and A. Kerr ..................... 110
ICP-Monitoring in the Middle Cranial Fossa. A Comparison Between the
Intraventricular Method and the Introduction of a Catheter Tip Transducer
into the Parasellar Cistern via the Foramen Ovale
H.-u. ThaI ...................................................... 116
Characteristics of a New ICP Monitoring Device
E.L. McCleary and P.R. Cooper. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 122
Accurate Intracranial Pressure Monitoring
CB. Shields, H.D. Garretson, R. Roski, and c.P. McGraw . .............. 124
Chronic Monitoring of Intraventricular Pressure in Children Using
Telemetry: Engineering and Physiologic Aspects
H.L. Rekate, D. Fleming, A. Leung, W. Ko, and F.E. Nulsen ............... 127
Experiences with a New Telemetric Pressure Meter
K. Osaka, T. Maeda, T. Ohta, and L Sakaguchi .......................... 131
Usefulness of ICP Histogram and ICP Histogram Array in ICP Monitoring
H. Tsutsumi, H. Nishiyama, T. Aruga, H. Toyooka, K. Mii, M Tsuzuki,
S. Manaka, and K. Takakura . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 135
ICP Monitoring Combined with the Spectrum Analysis of EEG
H. Takizawa, K. Sugiura, M Baba, T. Chishiki, K. Muraoka,
T. Tach~awa,E. Kamathul~,andT.Kasai ............................. 140
Computerized Monitoring of ICP
R. Schedl, H. Benzer, P. Fasol, N Mutz, W. Sebek, H. Spangler,
and M Strickner ................................................. .145
Prediction of ICP and Pressure Wave Discrimination with Our Intelligent
Monitor System (IMNIC-l)
T. Ikeda, S. Nakatani, L Hagiwara, K. Nakao, K. Koshino, and H. Mogami ..... 150
Automatic ICP Controller: A New Device
K. Iwata, H. Yuasa, T. Sugiyama, and A. Yamazaki ....................... 157
Automated Cerebral Perfusion Pressure Control: A Preliminary Report
L Hagiwara and S. Nakatani ......................................... 163
Session B: Pulse Wave
CSF-Dynamics: Integration of Pulsatory Components and Autoregulation
into a Mathematical Model
o.
Hoffmann ................................................... 169
x
Starling Resistor as a Model of the Cerebrovascular Bed
M Chopp and RD. Portnoy............. .... .. ... .. ..... . . .. .. .... 174
CSF Pulse Wave, ICP, and Autoregulation
RD. Portnoy, M Chopp, C Branch, and M Shannon. . . . . . . . . . . . . . . . . . .. 180
Computer-Analysis of ICP-Modulations: Clinical Significance and
Prediction of ICP-Dynamics
A. Brawanski, MR. Gaab, and RE. Heif3ler ............................ 186
The CSF Pulse Pressure as Indicator of Intracranial Elastance: The Role of
the Pulsatile Changes in Cerebral Blood Volume
J.RM van Eijndhoven and CJ.J. Avezaat .............................. 191
ICP - Some Observations
K Loga muthu krishnan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 197
Analysis of the Pulse Waveform of ICP in Cases with Congenital
Heart Disease
S. Kuramoto, O. Nakashima, T. Shirouzu, N. Todo, and K. Oriyogi ..... " ... 201
Analysis of CSF Pulse Wave of Cats
A. Gega, S. Utsumi, Y. Iida, and N. Iida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 206
Conduction Time of the Pulse Through the Brain with Increased
Intracranial Pressure
M Nitta, Y. Kasuga, Y. Hasegawa, and R Nagai ......................... 211
Changes of Epidural Pulse Waveform in Increased Intracranial Pressure
O. Hirai, R Handa, and M Ishikawa .................................. 216
Session C: Pressure-Volume Study
New Aspects of Cerebrospinal Fluid Circulation Models with Emphasis
on the Stability of the Model Parameters
J.RM van Eijndhoven and CJ.J. Avezaat ...................... , ........ 227
An Automated Method of Measurement of Intracranial Mechanical
Properties
St.R Graham, ME. Miner, D.L. Drennon, and L.E. Hackenberry ............ 234
The Calculation of Brain Elastic Response Parameters in Vivo
E.K. Walsh, A. Schettini, and R. Fitzer ................................ 239
The Effects of Cortical Cold Lesion on the Intracranial Pressure-Volume
Relationship of Brain Elasticity
R.A. Johnston, M Linder, and F.R Sklar .............................. 245
Pressure Volume Changes in Isobaric Brain Impaction
A. Marmarou, T. Nakamura, K. Tanaka, and K Shapiro ................... 248
The CSF Volume/Pressure Relationship in Man
R Friden and J. Ekstedt ........................................... 252
Pressure-Volume Diagram, Pulse Amplitude and Intracranial Pulse Volume.
Analysis and Significance
MR Gaab, L Haubitz, A. Brawanski, J. Faulstich, and RE. Heif31er .......... 261
XI
Does "Cortisol Ejection" Disturb PSDICP During CPERT Test?
1. Szewczykowski, B. Szukalski, 1. Korsak-Sliwka, E. Taracha,
G. Pawlowski, and S. Sliwka . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. 269
ICPjCPP Measurements and Analysis of the Cerebral Elastance Curve with
a Microcomputerized System for Neurosurgical Intensive Care
R. Urciuoli, G. Lo Russo, R.M Ponzio, and S. Zeme . . . . . . . . . . . . . . . . . . . .. 276
Brain Elastic Parameters and Cerebral Hemodynamics in Hemorrhagic
Hypotension
A. Schettini and E.K. Walsh.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 282
Comparison of Bolus and Constant Infusion Techniques for Determining the
Resistance of the Absorption of CSF
K. Shapiro, A. Marmarou, and E. Conway. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 286
The Effect of Craniectomy on the Intracranial Pressure-Volume Relationship
and Its Rlevance to the Syndrome of Shunt Dependent Ventricles
F.H. Sklar, M Linder, and R.A. Johnston .............................. 291
Session D: ICP Oscillation (Cerebrovascular Aspect)
Plateau Wave Etiology
J.R. Searle and H. G. Sullivan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 297
The Etiology of Plateau Waves: A Theoretical Model and Experimental
Observations
M.1. Rosner and D.P. Becker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 301
Oscillating Cerebral Blood Volume: The Origin of B-Waves
L Sayama and L.M. Auer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 307
The Role of Intracranial Blood Volume in Mechanical and
Pharmacological Decompression
M. Taneda, A. Wakayama, K. Ozaki, and K. Yagi .. ...................... 312
Relationship of Cerebral Blood Volume Changes and Estimated
Intracranial Compliance
L Nyary and J. Vajda .............................................. 316
Compliance-Estimation of Isolated Spinal Fluid Space in Humans
J. Vajda and L Nyary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 320
The Conflict Between CSF Pulse Pressure and Volume-Pressure
Response During Plateau Waves
c.J.J. Avezaat and l.H.M van Eijndhoven ............................. 326
Vasomotor Response in Acute Intracranial Hypertension
S. Yamamoto, S. Higashi, H. Fujii, M Hayashi, and H. Ito ................. 333
Importance of Cerebral 02 Extraction Reserve During Elevated
Intracranial Pressure in Young Lambs
J.E. Backofen, R.C. Koehler, R.J. Traystman, MD. Jones, and
MC. Rogers ..................................................... 338
XII
Sympathoadrenergic Modulation of Cerebral Blood Volume
During Increased ICP
L.M. Auer, I. Sayama, B.B. Johansson, and K. Leber. . . . . . . . . . . . . . . . . . . .. 342
Cerebral Venous Circulation Mechanism During Intracranial
Hypertension
N. Hayashi, T. Tsubokawa, and N. Moriyasu ............................ 348
Possible Mechanism Influencing Decrease of Intracranial Pressure
Occurring Following Arousal
M. Motomiya, Y. Nakagawa, H. Kinomoto, S. Mabuchi, and M Tsuru ........ 352
ICP Changes During Sleep in Man
M Ogashiwa and K. Takeuchi ....................................... 358
Session E: Blood Brain Barrier and Brain Edema
Anatomical Studies of Blood Brain Barrier Disruption Following
Intracarotid Bile Salt Infusion
M.E. Levine, M.K. Spigelman, R.A. Zapulla, 1. T. Povlishock,
L.I. Malis, and J.F. Holland. . . . . . . . .. .............................. 367
Aminobenzyl Penicillin Penetration Through Blood-Brain Barrier in
Experimental Brain Edema
M Yamaguchi and S. Matsumoto .................................... .371
Comparative Reassessment of the Gravimetric and the
Drying-Weighing Methods
S. Shigeno, T. Shigeno, M Brock, E. Fritschka, and 1. Cervos-Navarro ........ 375
Alterations of Brain Water with Increased Intracranial Pressure
1. Traina and R.O. Dunker ......................................... 380
Intracranial Pressure and Extracellar Bulk Flow in Hyposmolar Edema
R. O. Dunker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Changes of Osmolality of Brain, Cerebrospinal Fluid and Plasma in
Acute Cytotoxic Edema in Cats
Y. Matsuoka, S. Nishimura,and K.-A. Hossmann ......................... 389
Ischemic Brain Edema: Cytotoxic and Vasogenic Factors
T. Shigeno, E. Fritschka, M. Brock,and S. Shigeno ....................... 394
Ischemic Brain Edema and the Glutathione System
O. Gotoh, T. Asano, A. Tamura, and K. Takakura . . . . . . . . . . . . . . . . . . . . . .. 399
The Effect of High Intracranial Pressure on Activation and Release of
Mediator Compounds in Traumatic Vasogenic Brain Edema
A. Baethmann, K. Maier-Hauff, L. Schurer, M Lange, O. Kempski,
and A. Unterberg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 405
Electrophysiological and Regional Cerebral Blood Flow Changes
Associated with Direct Infusion Edema
K. Tanaka, A. Marmarou, and S. Nishimura ............................ 413
XIII
