Brain tissue oxygen pressure monitoring in awake patients during functional neurosurgery: the assessment of normal values.
Local brain tissue oxygen (ptiO2) monitoring is frequently applied in patients at risk for cerebral ischemia. To identify ischemic thresholds, the normal range of local brain tissue oxygen pressure (ptiO2) values needs to be established. Ideally, such normal values are determined in healthy and awake subjects, so as to eliminate the possible influences of anesthetics on cerebral physiology or ptiO2. Thus far, however, such measurements have not been conducted, and to fill this void, we determined the ptiO2 values in normal white matter of awake patients undergoing functional stereotactic brain surgery. In 25 otherwise healthy patients, who underwent functional neurosurgery for treatment of a refractory movement disorder under local anesthesia, the ptiO2 of white matter was recorded continuously using a polarographic Clark type electrode monitoring system. Preoperative screening ruled out cognitive dysfunction or structural cerebral lesions. Reliable intraoperative ptiO2 values were obtained in 22 patients. After an adaptation period of 118+/-35 min (range, 47-171 min), we found an average normal ptiO2 of 22.6+/-7.2 mm Hg in the frontal white matter. In 11 patients, ptiO2 measurements were continued postoperatively for 24 h. During this period, a similar normal ptiO2 value of 23.1+/-6.6 mm Hg was found. No iatrogenic complications occurred. In conclusion, the normal ptiO2 of cerebral white matter is most likely lower than previously assumed. Further, the long adaptation time renders this widely applied monitoring instrument unreliable in detecting ischemia early after insertion and limits its usefulness for intraoperative monitoring.
Division of Neurosurgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.
Frederik A
FA
Pennings
P Richard
PR
Schuurman
Pepijn
P
van den Munckhof
Gerrit J
GJ
Bouma
D000222:Adaptation, Physiological / Q000502:physiology; D000328:Adult; D000368:Aged; D001921:Brain / Q000378:metabolism* / Q000601:surgery; D002545:Brain Ischemia / Q000175:diagnosis / Q000378:metabolism / Q000517:prevention & control; D004566:Electrodes / Q000592:standards; D004594:Electrophysiology / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D009413:Nerve Fibers, Myelinated / Q000378:metabolism; D019635:Neurosurgical Procedures / Q000379:methods*; D010100:Oxygen / Q000032:analysis* / Q000378:metabolism*; D010101:Oxygen Consumption / Q000502:physiology; D011048:Polarography / Q000295:instrumentation / Q000379:methods*; D012016:Reference Values; D013238:Stereotaxic Techniques
D010100:Oxygen