Editorial
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 14, 2006; 12(46): 7405-7412
Published online Dec 14, 2006. doi: 10.3748/wjg.v12.i46.7405
Brain edema and intracranial hypertension in fulminant hepatic failure: Pathophysiology and management
Olivier Detry, Arnaud De Roover, Pierre Honoré, Michel Meurisse
Olivier Detry, Arnaud De Roover, Pierre Honoré, Michel Meurisse, Department of Abdominal Surgery and Transplantation, University of Liège, CHU Sart Tilman B35, B4000 Liège, Belgium
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Olivier Detry, Department of Abdominal Surgery and Transplantation, CHU Sart Tilman B35, B4000 Liège, Belgium. oli.detry@chu.ulg.ac.be
Telephone: +32-4-3667645 Fax: +32-4-3667069
Received: May 16, 2006
Revised: June 5, 2006
Accepted: June 14, 2006
Published online: December 14, 2006
Abstract

Intracranial hypertension is a major cause of morbidity and mortality of patients suffering from fulminant hepatic failure. The etiology of this intracranial hypertension is not fully determined, and is probably multifactorial, combining a cytotoxic brain edema due to the astrocytic accumulation of glutamine, and an increase in cerebral blood volume and cerebral blood flow, in part due to inflammation, to glutamine and to toxic products of the diseased liver. Validated methods to control intracranial hypertension in fulminant hepatic failure patients mainly include mannitol, hypertonic saline, indomethacin, thiopental, and hyperventilation. However all these measures are often not sufficient in absence of liver transplantation, the only curative treatment of intracranial hypertension in fulminant hepatic failure to date. Induced moderate hypothermia seems very promising in this setting, but has to be validated by a controlled, randomized study. Artificial liver support systems have been under investigation for many decades. The bioartificial liver, based on both detoxification and swine liver cells, has shown some efficacy on reduction of intracranial pressure but did not show survival benefit in a controlled, randomized study. The Molecular Adsorbents Recirculating System has shown some efficacy in decreasing intracranial pressure in an animal model of liver failure, but has still to be evaluated in a phase III trial.

Keywords: Intracranial hypertension; Fulminant hepatic failure; Brain edema