Effect of intrathecal saline injection and Valsalva maneuver on cerebral perfusion pressure during transsphenoidal surgery for pituitary macroadenoma.
Cerebrospinal fluid pressure (CSFP) was monitored through a lumbar intrathecal catheter in 32 patients undergoing transsphenoidal excision of pituitary macroadenomas. In the first 20 patients, standardized intermittent Valsalva maneuvers were followed by intrathecal saline injections in 2.5-ml increments. Their effects on CSFP, mean arterial pressure (MAP), and therefore, cerebral perfusion pressure (CPP) were compared. The increase in CSFP produced by one Valsalva maneuver (4 +/- 2 mm Hg) was similar to that produced by a single increment of intrathecal saline (4 +/- 2 mm Hg), but the effect of saline was more sustained. With Valsalva maneuvers, the maximum CSFP produced was 13 +/- 4 mm Hg, and the CPP decreased to 50 +/- 14 mm Hg, whereas with saline, the maximum CSFP was 25 +/- 7 mm Hg, and the CPP decreased to 59 +/- 13 mm Hg. Because the increase in CSFP was greater and better sustained with intrathecal saline, Valsalva maneuvers were omitted in the next 12 patients. Peroperative data, including surgical conditions, and post-operative morbidity, with special reference to low-pressure headache and meningeal infection, were analyzed in all 32 patients. Operative conditions produced with intrathecal saline were judged excellent or good in 75% of patients. However, because this technique can decrease the CPP excessively, we recommend that it be used only with continuous CSFP monitoring.
Nath
G
G
Christian Medical College Hospital, Vellore, India.
Korula
G
G
Chandy
M J
MJ
D000236:Adenoma / Q000601:surgery*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D015170:Cerebrospinal Fluid Pressure / Q000187:drug effects / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007278:Injections, Spinal; D007427:Intracranial Pressure / Q000187:drug effects / Q000502:physiology*; D007431:Intraoperative Complications; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage / Q000494:pharmacology*; D013100:Sphenoid Bone / Q000601:surgery; D014636:Valsalva Maneuver
D012965:Sodium Chloride