[Intraoperative detection of ischemic brain hypoxia using oxygen tissue pressure microprobes].
OBJECTIVE
Detection of intraoperative ischemic events could lead to the resolution of their cause and to the prevention of the definitive establishment of a postoperative infarct. We want to illustrate the possibilities that intraoperative monitoring of oxygen tissue pressure (PtiO2) in critical areas during a neurosurgical vascular procedure offers, enhancing its reliability and immediacy in obtaining information about tissue oxygenation status as a marker of ischemia in the vascular territory at risk.


METHODS
We report the case of a 32 year-old male with a deep arteriovenous malformation (AVM) localised in the insular region. The patient had been previously treated with radiosurgery without achieving a satisfactory result.


METHODS
AVM removal was performed through a transylvian transinsular approach. PtiO2 was monitorised at the temporal pole (reference area) and at the posterior temporal region (risk area). Both probes maintained close tissue oxygenation levels until the last stage of the AVM resection when, during the coagulation of a supposed afferent vessel, a brisk fall of the oxygen tissue pressure in the posterior temporal region was detected. An ischemic infarct in this area was observed postoperatively.


CONCLUSIONS
PtiO2 monitoring has a high reliability in the detection of intraoperative tissue hypoxia. Data obtained could lead to early identification of these events and, whatever possible, to resolve this situation preventing the definitive establishment of an ischemic infarct.
Ibáñez
J
J
Unidad de Neurotraumatología, Institut de Reccerca Vall d'Hebron. Universidad Autónoma. Barcelona. Spain.
Vilalta
A
A
Mena
M P
MP
Vilalta
J
J
Topczewski
T
T
Noguer
M
M
Sahuquillo
J
J
Rubio
E
E
D000328:Adult; D001785:Blood Gas Monitoring, Transcutaneous / Q000295:instrumentation; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000601:surgery*; D007430:Intraoperative Care; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D013702:Temporal Lobe / Q000098:blood supply; D014057:Tomography, X-Ray Computed