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Acta Neurochir (Wien). 1999;141(11):1221-7 discussion 1226-7.

Assessment of critical closing pressure in the cerebral circulation as a measure of cerebrovascular tone.

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MRC Cambridge Centre for Brain Repair and Academic Neurosurgery Unit, Addenbrooke's Hospital, Cambridge, UK.


Critical closing pressure (CCP) calculated from the blood flow velocity (FV) and arterial blood pressure (ABP) waveforms has been previously reported to be useful in the assessment of the dynamics of cerebral circulation. We investigated the relationship between CCP and intracranial pressure (ICP) and cerebrovascular tone in a model of intracranial hypertension in 22 anaesthetised New Zealand White rabbits during manipulations of arterial CO2, ABP and vasodilatation caused by hypoxia. Recordings were made of FV in the basilar artery, ABP and ICP during subarachnoid infusion of saline. During infusion ICP and CCP were significantly correlated (R=0.68; p<0.001), but the magnitude of increase in ICP and CCP during infusion were not correlated to each other. Linear regression between the difference: CCP-ICP (representing a factor due to vasogenic tone) and cerebral perfusion pressure (CPP=ABP-ICP) was highly significant (R=-0.87; p<0.01). Generally, CCP decreased significantly (p<0.05) with hypercarbia, arterial hypotension and after and post-hypoxia and the difference: CCP-ICP decreased consistently after each vasodilatatory manoeuvre studied. Our data confirmed the linear relationship between CCP and ICP, and between the difference: CCP-ICP and cerebrovascular tone. However, because the magnitude of increase in ICP was not correlated to magnitude of change in CCP, CCP cannot be use for detection of increasing ICP quantitatively.

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