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3 - Wireless Intracranial Pressure Systems for the Assessment of Traumatic Brain Injury

Xu Meng
Affiliation:
Drexel University
Kevin D. Browne
Affiliation:
University of Pennsylvania
D. Kacy Cullen
Affiliation:
University of Pennsylvania
Mohammad-Reza Tofighi
Affiliation:
Pennsylvania State University
Usmah Kawoos
Affiliation:
Naval Medical Research Center
Arye Rosen
Affiliation:
Drexel University
Isar Mostafanezhad
Affiliation:
University of Hawaii, Manoa
Olga Boric-Lubecke
Affiliation:
University of Hawaii, Manoa
Jenshan Lin
Affiliation:
University of Florida
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Summary

A significant reason for death and long-term disability due to head injuries and pathologic conditions is an elevation in the intracranial pressure (ICP) due to vascular compromise and secondary sequelae causing edema. ICP measurements before and after injury in a completely closed-head environment have a significant research value, particularly in the acute postinjury period. With current technology, a tethered fiberoptic probe penetrates the brain and therefore can only remain implanted for relatively short time periods. Use of the probe also can cause complications such as infection and hemorrhage and prohibit immediate (at the time of injury) and long-term measurements of ICP. A small, fully embedded, wireless ICP device may simplify clinical management and research protocols by offering a means for semi-invasive and long-term ICP measurement following brain injury. In this chapter, a new digital wireless ICP (DICP) device is described. The dynamic ICP measurement performances of both the analog ICP (AICP) devices (described in Chapter 2) and the DICP devices are evaluated in a specific traumatic brain injury (TBI) (swine) model of closed-head rotational injury.

Introduction

In Chapter 2, a prototype of an AICP device operating in the industrial-scientific-medical (ISM) band at 2.4 GHz was described that successfully simplified the surgical procedure by reducing the infection rate, the risk of hemorrhage, and the degree of tissue injury.

The AICP device was implanted in a canine model only for a static test, and hypo- and hyperventilation were used to affect variations in ICP. Dynamic ICP variations as a result of TBI in a completely closed-head environment are of paramount importance for understanding the development of a prolonged postconcussion syndrome and facilitating institution of the correct treatment at different stages, particularly in the acute postinjury period. Currently, in experimental (animal) models of TBI, a tethered fiberoptic probe (if inserted before the injury) has to be removed before an injury is induced in order to avoid significant focal damage at the point of probe insertion. Moreover, reinsertion of the probe is possible only after the animal's vital signs have stabilized. However, the act of breaching the cranium after the injury affects the fidelity of the ICP measurements. In addition, proposed noninvasive ICP (NICP) solutions, such as the pulsatility index method based on the use of trancranial Doppler, argued by Figaji et al. [1], have been shown to be insufficient for accurate ICP estimation.

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Publisher: Cambridge University Press
Print publication year: 2017

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References

[1] Figaji, A. A., Zwane, E., Fieggen, A. G., Siesjo, P., and Peter, J. C., “Transcranial doppler pulsatility index is not a reliable indicator of intracranial pressure in children with severe traumatic brain injury,” Surg. Neurol. 72(4) (2009): 389–94.CrossRefGoogle Scholar
[2] Faul, M., Xu, L., Wald, M., and Coronado, V., “Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths,” Centers for Disease Control and Prevention and Center for Injury Prevention and Control, Atlanta, 2010.
[3] Zomeren, A. H. Van and Saan, R. J., “Psychological and social sequelae of severe head injury,” in Handbook of Clinical Neurology, ed. Braakman, R. (New York: Elsevier Science, 1990).Google Scholar
[4] King, A. I., Yang, K. H., Zhang, L., Hardy, W., and Viano, D. C.., “Is head injury caused by linear or angular acceleration?,” in International Research Conference on the Biomechanics of Impact (IRCOBI) (Zurich IRCOBI, 2003).
[5] Rowson, S. and Duma, S. M., “Brain injury prediction: assessing the combined probability of concussion using linear and rotational head acceleration,” Ann. Biomed. Eng. 41(5) (2013): 873–82.CrossRefGoogle ScholarPubMed
[6] Holburn, A. H. S., “Mechanics of head injuries,” Lancet 2 (1943):438–41.Google Scholar
[7] Gadd, C. W., “Use of a weighted impulse criterion for estimating injury hazard,” in 10th Stapp Car Crash Conference (London: SAE International, 1966, pp. 164–74.Google Scholar
[8] Versac, J., “A review of severity of index,” SAE Technical Paper 710881, SAE, Detroit, 1971.
[9] Lissner, H. R., Lebow, M., and Evans, F. G., “Experimental studies on the relation between acceleration and intracranial pressure changes in man,” Surg. Gynecol. Obstet. 111 (1960): 329–38.Google ScholarPubMed
[10] Zhang, L. Y., Yang, K. H., and King, A. I., “A proposed injury threshold for introduction mild traumatic brain injury,” J. Biomech. Eng. ASME 126(2) (2004): 226–36.CrossRefGoogle Scholar
[11] Zink, B. J., “Traumatic brain injury,” Emerg. Med. Clin. North Am. 14(1) (1996): 115–50.CrossRefGoogle ScholarPubMed
[12] Povlishock, J. T., “Traumatically induced axonal injury: pathogenesis and pathobiological implications,” Brain Pathol 2(1) (1992): 1–12.Google ScholarPubMed
[13] Povlishock, J. T., “Pathobiology of traumatically induced axonal injury in animals and man,” Ann. Emerg. Med. 22(6) (1993): 980–6.CrossRefGoogle ScholarPubMed
[14] Kaiser, Ch., Schnabel, A., Berkefeld, J., and Bratzke, H., “Traumatic rupture of the tntracranial vertebral artery due to rotational acceleration,” Forensic Sci. Int. 182(1–3) (2008): e15–17.CrossRefGoogle ScholarPubMed
[15] Ross, D. T., Meaney, D. F., Sabol, M. K., Smith, D. H., and Gennarelli, T. A., “Distribution of forebrain diffuse axonal injury following inertial closed head injury in miniature swine,” Exp. Neurol. 126(2) (1994): 291–9.CrossRefGoogle ScholarPubMed
[16] Smith, D. H., Chen, X. H., Xu, B. N., Mcintosh, T. K., Gennarelli, T. A., et al., “Characterization of diffuse axonal pathology and selective hippocampal damage following inertial brain trauma in the pig,” J. Neuropathol. Exp. Neurol. 56(7) (1997): 822–34.CrossRefGoogle ScholarPubMed
[17] Kimura, H., Meaney, D. F., Mcgowan, J. C., Grossman, R. I., Lenkinski, R. E., et al., “Magnetization transfer imaging of diffuse axonal injury following experimental brain injury in the pig: characterization by magnetization transfer ratio with histopathologic correlation,” J. Comput. Assist. Tomogr. 20(4)(1996): 540–6.CrossRefGoogle ScholarPubMed
[18] Cecil, K. M., Lenkinski, R. E., Meaney, D. F., Mcintosh, T. K., and Smith, D. H., “High-field proton magnetic resonance spectroscopy of a swine model for axonal injury,” J Neurochem. 70(5) (1998): 2038–44.Google ScholarPubMed
[19] Mcgowan, J. C., Mccormack, T. M., Grossman, R. I., Mendonca, R., Chen, X. H., et al., “Diffuse axonal pathology detected with magnetization transfer imaging following brain injury in the pig,” Magn. Reson. Med. 41(4)(1999): 727–33.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
[20] Smith, D. H., Nonaka, M., Miller, R., Leoni, M., Chen, X. H., et al., “Immediate coma following inertial brain injury dependent on axonal damage in the brainstem,” J. Neurosurg. 93(2) (2000): 315–22.CrossRefGoogle ScholarPubMed
[21] Zhang, J., Groff, R. F. Th., n, X. H. Che, Browne, K. D., Huang, J., et al., “Hemostatic and neuroprotective effects of human recombinant activated factor vii therapy after traumatic brain injury in pigs,” Exp. Neurol. 210(2) (2008): 645–55.CrossRefGoogle ScholarPubMed
[22] Browne, K. D., Chen, X. H., Meaney, D. F., and Smith, D. H., “Mild traumatic brain injury and diffuse axonal injury in swine,” J. Neurotrauma 28(9) (2011): 1747–55.CrossRefGoogle ScholarPubMed
[23] Arbogast, K. B. and Margulies, S. S., “Material characterization of the brainstem from oscillatory shear tests,” J. Biomech. 31(9) (1998): 801–7.CrossRefGoogle ScholarPubMed
[24] Raghupathi, R., Mehr, M. F., Helfaer, M. A., and Margulies, S. S., “Traumatic axonal injury is exacerbated following repetitive closed head injury in the neonatal pig,” J. Neurotrauma 21(3) (2004): 307–16.CrossRefGoogle ScholarPubMed
[25] Zhou, C., Eucker, S. A., Durduran, T., Yu, G., Ralston, J., et al., “Diffuse optical monitoring of hemodynamic changes in piglet brain with closed head injury,” J. Biomed. Opt. 14(3) (2009): 34–45.CrossRefGoogle ScholarPubMed
[26] Coats, B., Binenbaum, G., Peiffer, R. L., Forbes, B. J., and Margulies, S. S., “Ocular hemorrhages in neonatal porcine eyes from single, rapid rotational events,” Invest. Ophthalmol. Vis. Sci. 51(9) (2010): 4792–7.CrossRefGoogle ScholarPubMed
[27] Eucker, S. A., Smith, C., Ralston, J., Friess, S. H., and Margulies, S. S., “Physiological and histopathological responses following closed rotational head injury depend on direction of head motion,” Exp. Neurol. 227(1) (2011): 79–88.CrossRefGoogle ScholarPubMed
[28] O'connor, W. T., Smyth, A., and Gilchrist, M. D., “Animal models of traumatic brain injury: a critical evaluation,” Pharmacol. Ther. 130(2) (2011): 106–13.CrossRefGoogle ScholarPubMed
[29] Freire, M. A., “Pathophysiology of neurodegeneration following traumatic brain injury,” West Indian Med. J. 61(7) (2012): 751–5.Google ScholarPubMed
[30] Raghupathi, R. and Margulies, S. S., “Traumatic axonal injury after closed head injury in the neonatal pig,” J. Neurotrauma 19(7) (2002): 843–53.CrossRefGoogle ScholarPubMed
[31] Meng, X., Browne, K., Huang, S. M., Cullen, D. K., Tofighi, M. R., et al., “Dynamic study of wireless intracranial pressure monitoring of rotational head injury in swine model,” Electron. Lett. 48(7) (2012): 363–4.CrossRefGoogle Scholar
[32] Texas Instruments, Ez430-rf2500 Development Tool User's Guide (rev. E), slau227e datasheet, April 2009.
[33] Meng, X., Tofighi, M. R., and Rosen, A., “Digital microwave system for monitoring intracranial pressure in hydrocephalic and traumatic brain injury patients,” IEEE MTT-S International Microwave Symposium Digest (Piscataway, NJ: IEEE, 2011), pp. 1–4.Google Scholar
[34] Meng, X., Browne, K. D., Huang, S. M., Mietus, C., Cullen, D. K., et al., “Dynamic evaluation of a digital wireless intracranial pressure sensor for the assessment of traumatic brain injury in a swine model,” IEEE Trans. Microw. Theory & Techn. 61(1) (2013): 316–25.CrossRefGoogle Scholar
[35] Kawoos, U., Tofighi, M. R., Warty, R., Kralick, F. A., and Rosen, A., “In-vitro and in-vivo trans-scalp evaluation of an intracranial pressure implant at 2.4 GHz,” IEEE Trans. Microw. Theory & Techn. 56(10) (2008): 2356–65.CrossRefGoogle Scholar
[36] Warty, R., Tofighi, M. R., Kawoos, U., and Rosen, A., “Characterization of implantable antennas for intracranial pressure monitoring: reflection by and transmission through a scalp phantom,” IEEE Trans. Microw. Theory & Techn. 56(10) (2008): 2366–76.CrossRefGoogle Scholar
[37] Tofighi, M. R., “Characterization of biomedical antennas for microwave heating, radiometry, and implant communication applications,” in 12th Annual IEEE Wireless and Microwave Technology Conference (Piscataway, NJ: IEEE, 2011), pp. 1–6.Google Scholar
[38] Kawoos, U., “Embedded wireless intracranial pressure monitoring implant at microwave prequencies.” Ph.D. dessertation, School of Biomedical Engineering, Drexel University, Philadelphia, 2009.
[39] Warty, R., “ISM band antenna scattering from scalp phantom for intracranial pressure monitoring implants,” Master's thesis, School of Electrical and Computer Engineering, Drexel University, Philadelphia, 2008.
[40] Tofighi, M. R. and Huang, S. M.., “Radiation efficiency of planar implantable antennas at ism band,” in 2014 IEEE Topical Conference on Biomedical Wireless Technologies, Networks, and Sensing Systems (Piscataway, NJ: IEEE, 2014).Google Scholar
[41] Cernak, I., “Animal models of head trauma,” NeuroRx. 2(3) (2005): 410–22.CrossRefGoogle ScholarPubMed
[42] Xiong, Y., Mahmood, A., and Chopp, M., “Animal models of traumatic brain injury,” Nat. Rev. Neurosci. 14(2) (2013): 128–42.CrossRefGoogle ScholarPubMed
[43] Villar, I. Del, “Fiber optic glucose biosensor,” Opt. Eng. 45(10) (2006): 104401.CrossRefGoogle Scholar
[44] Moore, M., “Mild traumatic brain injury: Implications for social work research and practice with civilian and military populations,” Soc. Work Health Care 52(5) (2013): 498–518.CrossRefGoogle ScholarPubMed
[45] Metting, Z., Cerliani, L., Rodiger, L. A., and Naalt, J. Van Der, “Pathophysiological concepts in mild traumatic brain injury: diffusion tensor imaging related to acute perfusion ct imaging,” PLoS One 8(5) (2013): 644–61.CrossRefGoogle ScholarPubMed
[46] Naalt, J. Van Der, “Prediction of outcome in mild to moderate head injury: a review,” J. Clin. Exp. Neuropsychol. 23(6) (2001): 837–51.CrossRefGoogle ScholarPubMed
[47] Belanger, H. G., Curtiss, G., Demery, J. A., Lebowitz, B. K., and Vanderploeg, R. D., “Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis,” J. Int. Neuropsychol. Soc. 11(3) (2005): 215–27.CrossRefGoogle ScholarPubMed
[48] Wieser, G. L., Gerwig, U. C., Adamcio, B., Barrette, B., Nave, K. A., et al., “Neuroinflammation in white matter tracts of cnp1 mutant mice amplified by a minor brain injury,” Glia 61(6) (2013): 869–80.CrossRefGoogle ScholarPubMed
[49] Smith, D. H., Johnson, V. E., and Stewart, W., “Chronic neuropathologies of single and repetitive TBI: substrates of dementia?,” Nat. Rev. Neurol. 9(4) (2013): 211–21.CrossRefGoogle Scholar
[50] Sidoryk-Wegrzynowicz, M. and Aschner, M., “Role of astrocytes in manganese mediated neurotoxicity,” BMC Pharmacol. Toxicol. 14 (2013): 23.CrossRefGoogle ScholarPubMed
[51] Lakis, N., Corona, R. J., Toshkezi, G., and Chin, L. S., “Chronic traumatic encephalopathy-neuropathology in athletes and war veterans,” Neurol. Res. 35(3) (2013): 290–9.CrossRefGoogle ScholarPubMed
[52] Faden, A. I., “Pharmacologic treatment of acute traumatic brain injury,” JAMA 276 (7) (1996): 569–70.CrossRefGoogle ScholarPubMed
[53] Mcintosh, T. K., Juhler, M., and Wieloch, T., “Novel pharmacologic strategies in the treatment of experimental traumatic brain injury: 1998,” J. Neurotrauma 15(10) (1998): 731–69.CrossRefGoogle ScholarPubMed
[54] Faden, A. I., “Neuroprotection and traumatic brain injury: theoretical option or realistic proposition,” Curr. Opin. Neurol. 15(6) (2002): 707–12.CrossRefGoogle ScholarPubMed
[55] Vink, R. and Nimmo, A. J., “Novel therapies in development for the treatment of traumatic brain injury,” Expert Opin. Invest. Drugs 11(10) (2002): 1375–86.CrossRefGoogle ScholarPubMed
[56] Ursino, M. and Lodi, C. A., “A simple mathematical model of the interaction between intracranial pressure and cerebral hemodynamics,” J. Appl. Physiol. 82(4) (1997): 1256–69.CrossRefGoogle ScholarPubMed
[57] Wakeland, W. and Goldstein, B., “A computer model of intracranial pressure dynamics during traumatic brain injury that explicitly models fluid flows and volumes,” Acta Neurochir. Suppl. 95 (2005) :321–6.Google ScholarPubMed
[58] Ursino, M. and Digiammarco, P., “A mathematical-model of the relationship between cerebral blood-volume and intracranial-pressure changes – the generation of plateau waves,” Ann. Biomed. Eng. 19(1) (1991): 15–42.CrossRefGoogle ScholarPubMed
[59] Lakin, W. D., Stevens, S. A., Tranmer, B. I., and Penar, P. L., “A whole-body mathematical model for intracranial pressure dynamics,” J. Math. Biol. 46(4) (2003): 347–83.CrossRefGoogle ScholarPubMed
[60] Byard, R. W., Gabrielian, L., Helps, S. C., Thornton, E., and Vink, R., “Further investigations into the speed of cerebral swelling following blunt cranial trauma,” J. Forensic Sci. 57(4) (2012): 973–5.CrossRefGoogle ScholarPubMed
[61] Barzo, P., Marmarou, A., Fatouros, P., Hayasaki, K., and Corwin, F., “Contribution of vasogenic and cellular edema to traumatic brain swelling measured by diffusion-weighted imaging,” J. Neurosurg. 87(6) (1997): 900–7.CrossRefGoogle ScholarPubMed

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