Abstract:
BACKGROUND:Accidental vessel occlusion is one major risk of intracranial aneurysm surgery potentially causing cerebral ischemia. The intraoperative assessment of cerebral ischemia remains a technological challenge. OBJECTIVE:As a novel approach, cortical tissue integrity was monitored using simultaneous measurements of regional capillary-venous cerebral blood flow (rvCBF), oxygen saturation (Srvo2), and hemoglobin amount (rvHb) during aneurysm surgery. METHODS:Fifteen patients scheduled for aneurysm surgery of the anterior and posterior circulation were included. A fiber optic probe was placed on the cortex associated with the distal branch of the aneurysmatic vessel. Blinded measurements by combined laser-Doppler flowmetry (rvCBF) and photospectrometry (Srvo2, rvHb) were performed before and after surgical clipping or trapping of the aneurysm. Data were correlated with postoperative imaging and neurological outcome. RESULTS:Cortical measurements could be successfully performed in all patients. Significant increase (>25% change from baseline) or decrease (<25% change from baseline) of rvCBF, Srvo2, and rvHb was detectable in 33 to 46% of patients after surgical intervention. Severe decrease (>50% change from baseline) of all parameters or solitary of rvCBF was correlated to reduced cerebral perfusion and neurological deficits in 2 patients. CONCLUSION:Combined laser-Doppler flowmetry and photospectrometry provides real-time information on cortical microcirculation. Intraoperative alterations of parameters (rvCBF, Srvo2, rvHb) might reflect changes of cerebral tissue integrity during intracranial aneurysm surgery.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Klein KU,Stadie A,Fukui K,Schramm P,Werner C,Oertel J,Engelhard K,Fischer Gdoi
10.1227/NEU.0b013e3182178bc9subject
Has Abstractpub_date
2011-08-01 00:00:00pages
391-8issue
2eissn
0148-396Xissn
1524-4040journal_volume
69pub_type
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