BRAIN PROTECTION STRATEGIES AND CONTROVERSIES
Keywords:
brain injury, CPP, autoregulation, aneurismAbstract
Relevant. Oxidative stress is the principal factor in brain injury that initiates the events that result in protracted neuronal dysfunction and remodeling. Importantly, antioxidants can protect the brain against oxidative damage and modulate the capacity of the brain to cope with synaptic dysfunction and cognitive impairment. But also we need to review other ways to protect brain tissue after intracranial tumors, cerebral ischemia, or traumatic brain injury. Methods. Cerebral blood flow abnormalities (e. g. in patients with vasospasm following subarachnoid hemorrhage or intracranial hypertension) require individualized approaches in managing CPP: Currently, two different CPP management strategies (philosophies) attempt to maintain cerebral perfusion at a level adequate to fuel the cerebral metabolic needs. Although both of these concepts differ with respect to the level of CPP either of them may be appropriate depending of the individual status of CBF autoregulation and the blood-brain-barrier. Conclusions. The plethora of perioperative pathophysiological events in patients scheduled for intracranial aneurysm surgery requires a holistic medical approach: It is essential to maintain homeostasis by controlling for normotension, normovolemia, normoxia, normocapnia, normothermia and mormoglycemia. Additionally, the use of oral nimodipine is indicated. There is inadequate evidence for the treatment with magnesium and statins. Erythropoietin, steroids, triple-H and intraoperative hypothermia are not indicated.
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