Continuous monitoring of regional cerebral blood flow during temporary arterial occlusion in aneurysm surgery.
OBJECTIVE
Temporary arterial occlusion (TAO) during aneurysm surgery carries the risk of ischemic sequelae. Because monitoring of regional cerebral blood flow (rCBF) may limit neurological damage, the authors evaluated a novel thermal diffusion (TD) microprobe for use in the continuous and quantitative assessment of rCBF during TAO.


METHODS
Following subcortical implantation of the device at a depth of 20 mm in the middle cerebral artery or anterior cerebral artery territory, rCBF was continuously monitored by TD microprobe (TD-rCBF) throughout surgery in 20 patients harboring anterior circulation aneurysms; 46 occlusive episodes were recorded. Postoperative radiographic evidence of new infarction was used as the threshold for failure of occlusion tolerance. The mean subcortical TD-rCBF decreased from 27.8+/-8.4 ml/100 g/min at baseline to 13.7+/-11.1 ml/100 g/min (p < 0.0001) during TAO. The TD microprobe showed an immediate exponential decline of TD-rCBF on clip placement. On average, 50% of the total decrease was reached after 12 seconds, thus rapidly indicating the severity of hypoperfusion. Following clip removal, TD-rCBF returned to baseline levels after an average interval of 32 seconds, and subsequently demonstrated a transient hyperperfusion to 41.4+/-18.3 ml/l 00 g/min (p < 0.001). The occurrence of postoperative infarction (15%) and the extent of postischemic hyperperfusion correlated with the depth of occlusion-induced ischemia.


CONCLUSIONS
The new TD microprobe provides a sensitive, continuous, and real-time assessment of intraoperative rCBF during TAO. Occlusion-induced ischemia is reliably detected within the 1st minute after clip application. In the future, this may enable the surgeon to alter the surgical strategy early after TAO to prevent ischemic brain injury.
Thomé
C
C
Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany. claudius.thome@nch.ma.uni-heidelberg.de
Vajkoczy
P
P
Horn
P
P
Bauhuf
C
C
Hübner
U
U
Schmiedek
P
P
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000503:physiopathology / Q000601:surgery; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D002245:Carbon Dioxide / Q000097:blood; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000503:physiopathology / Q000601:surgery*; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D010100:Oxygen / Q000097:blood; D012039:Regional Blood Flow / Q000502:physiology; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology / Q000601:surgery; D013525:Surgical Instruments; D013815:Thermodilution / Q000295:instrumentation*
D002245:Carbon Dioxide; D010100:Oxygen