Hyperosmolar Therapy and New Treatment of Increased Intracranial Pressure

Abstract

Since the Monro-Kelline doctorine has been complied in 1783 and explaining the skull parts and their relations, medical sciences has been tried to keep this relation and improve the brain blood circulation in pathological status. Introducing ICP monitoring by Key and Rotzing in 1875 and the ability to register the waves in 1886 by Knoll give the physicians a new outlook to treat the patients. Since then there have been many efforts to decrease the intracranial pressure in pathological conditions to get the normal level. One of the effective methods is hyperosmolar therapy in neurosurgeries to reduce the increased intracranial pressure. In this way using the saline solution 30% was began from 1919 by Weed and Mckibben which has been changed continuously curing the recent century using other hyperosmolar solutions (Urea, Glycerol and Sorbitol). In 1960s monnitol appearance was a big turning point (Knapp 2005) that replaced the others. During two previous decades different concentrations of saline solutions has been again considered and widely used. Comparing the basic clinical characteristics of hypertonic saline with monnitol make it more popular (Ogden et al. 2005). On one hand monnitol application especially in brain trauma has been called into question (Wakai et al. 2007) and on the other hand it’s more efficacy in decreasing the intracranial pressure than monnitol (White et al. 2006; Ziai et al 2007). So with review of the recent studies on evaluation and comparison the monnitol with routine clinical concentrations of hypertonic saline, we can say that hypertonic saline is the better choice.