• Klaus Ulrich Klein, Axel Stadie, Kimiko Fukui, Patrick Schramm, Christian Werner, Joachim Oertel, Kristin Engelhard, and Gerrit Fischer.
• Department of Anesthesiology, Medical Center of Johannes Gutenberg-University, Mainz, Germany. kuklein@uni-mainz.de
• Neurosurgery. 2011 Aug 1;69(2):391-8.

BackgroundAccidental vessel occlusion is one major risk of intracranial aneurysm surgery potentially causing cerebral ischemia. The intraoperative assessment of cerebral ischemia remains a technological challenge.ObjectiveAs 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.MethodsFifteen 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.ResultsCortical 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.ConclusionCombined 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.

28 keywords...

hide…