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

Authors

Nikolay L. Martirosyan, *Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; ‡Division of Neurosurgery, University of Arizona, Tucson, Arizona; §Division of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.Follow
M Yashar KalaniFollow
William D. Bichard
Ali A. Baaj
L Fernando Gonzalez
Mark C. Preul
Nicholas Theodore

Document Type

Article

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.

Medical Subject Headings

Animals; Cerebrospinal Fluid; Disease Models, Animal; Hemodynamics (physiology); Hypertension; Laser-Doppler Flowmetry; Male; Spinal Cord (blood supply); Spinal Cord Injuries (cerebrospinal fluid, physiopathology); Sus scrofa; Swine

Publication Date

4-1-2015

Publication Title

Neurosurgery

E-ISSN

1524-4040

Volume

76

Issue

4

First Page

461

Last Page

8; discussion 468

PubMed ID

25621979

Digital Object Identifier (DOI)

10.1227/NEU.0000000000000638

Recommended Citation

Martirosyan, Nikolay L.; Kalani, M Yashar; Bichard, William D.; Baaj, Ali A.; Gonzalez, L Fernando; Preul, Mark C.; and Theodore, Nicholas, "Cerebrospinal fluid drainage and induced hypertension improve spinal cord perfusion after acute spinal cord injury in pigs" (2015). Neurosurgery. 1673.
https://scholar.barrowneuro.org/neurosurgery/1673