title: Marked regional heterogeneity in venous oxygen saturation in severe head injury studied by superselective intracranial venous sampling: case report.
abstract: OBJECTIVE
  Continuous monitoring of jugular venous oxygen saturation (SjvO2) is useful in the management of severe head injury. Abnormally high SjvO2 values can be caused by increased cerebral blood flow, decreased cerebral metabolism, brain death, contamination from extracerebral venous blood, or traumatic arteriovenous fistula.
  
  
  METHODS
  A 20-year-old man with severe head injury was diagnosed to have a traumatic dural carotid-cavernous sinus fistula on the day of trauma. Continuous left SjvO2 monitoring from Days 4 to 12 revealed oxygen saturation ranging between 85 and 98%.
  
  
  METHODS
  Superselective intracranial and extracranial venous sampling on Day 5 demonstrated marked regional heterogeneity in venous oxygen saturation as follows: superior sagittal sinus, 95 to 97%; straight sinus, 88%; right transverse sinus, 94%; left transverse sinus, 74%; right SjvO2, 95%; left SjvO2, 89%; the basilar plexus, 99%; right internal jugular vein, 98%; the left internal jugular vein, 94%. Extremely high oxygen saturation in the superior sagittal sinus and basilar plexus was attributed to severe brain damage and carotid-cavernous sinus fistula, respectively.
  
  
  CONCLUSIONS
  Although jugular bulb oximetry is useful in the management of severe head injury, high oxygen saturation values should be interpreted with caution because they cannot show the intracranial heterogeneity of venous oxygen saturation.
authors.affiliation: Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Komiyama
authors.forename: M
authors.initials: M
authors.lastname: Kan
authors.forename: T
authors.initials: T
authors.lastname: Shigemoto
authors.forename: A
authors.initials: A
authors.lastname: Kaji
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D020216:Carotid-Cavernous Sinus Fistula / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D002533:Cerebral Angiography; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008991:Monitoring, Physiologic; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D012039:Regional Blood Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D010100:Oxygen