Neurosurgery
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It has been postulated that the Gosling pulsatility index (PI) assessed with transcranial Doppler (TCD) has a diagnostic value for noninvasive estimation of intracranial pressure (ICP) and cerebral perfusion pressure (CPP). ⋯ Overall, the value of TCD-PI to assess ICP and CPP noninvasively is very limited. However, extreme values of PI can still potentially be used in support of a decision for invasive ICP monitoring.
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Case Reports
Venous sinus pulsatility and the potential role of dural incompetence in idiopathic intracranial hypertension.
Idiopathic intracranial hypertension (IIH) remains a poorly understood and therapeutically challenging disease. Enthusiasm has emerged for endovascular therapy with stent reconstruction of dural sinus narrowing; however, a complete understanding of the hydrodynamic dysequilibrium is lacking. ⋯ We report the finding of high venous sinus pulsatility attenuation after stent implantation for dural sinus narrowing and propose the hypothesis that this finding is a marker of advanced dural sinus incompetence. This characteristic may be useful in identifying patients who would benefit from endovascular stent remodeling.
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Maintaining flow in a newly established high-flow bypass into the intracranial circulation may be threatened by low blood pressure. ⋯ Early postoperative mean arterial pressure less than approximately 60 mm Hg may induce blood flow in the bypass to decrease to less than 40 mL/min, a flow below which low shear stress may lead to early graft occlusion.