Brain Microdialysis

Cerebral microdialysis (CMD) is a minimally invasive means of providing bedside continuous monitoring of cerebral extracellular fluid, which can potentially detect secondary injuries occurring at the subcellular and molecular levels. CMD metabolites (namely lactate/pyruvate ratio, glucose, and glycerol) can be used to monitor the brain response to specific interventions, to assess the extent of injury, to identify potential novel biomarkers of injury and prognosis, and to help refine novel therapeutic approaches and drug effects on downstream targets. Over the last decade, CMD in combination with multimodal monitoring has been used to study brain-injured patients mainly severe traumatic brain injury (sTBI), aneurysmal subarachnoid hemorrhage (aSAH), intracerebral hemorrhage (ICH), intracranial tumors, acute ischemic stroke, epilepsy, and other neurological diseases. This review focuses on specific technical aspects related to CMD monitoring in neurocritical care patients, aiming to discuss its role in optimizing individualized intensive care therapy and to improve our understanding of the complex disease mechanisms occurring after severe brain injury.