PMID- 11565860
OWN - NLM
STAT- MEDLINE
DCOM- 20011004
LR  - 20131121
IS  - 0022-3085 (Print)
IS  - 0022-3085 (Linking)
VI  - 95
IP  - 3
DP  - 2001 Sep
TI  - Continuous monitoring of regional cerebral blood flow during temporary arterial 
      occlusion in aneurysm surgery.
PG  - 402-11
AB  - OBJECT: 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.
FAU - Thome, C
AU  - Thome C
AD  - Department of Neurosurgery, University Hospital Mannheim, University of 
      Heidelberg, Mannheim, Germany. claudius.thome@nch.ma.uni-heidelberg.de
FAU - Vajkoczy, P
AU  - Vajkoczy P
FAU - Horn, P
AU  - Horn P
FAU - Bauhuf, C
AU  - Bauhuf C
FAU - Hubner, U
AU  - Hubner U
FAU - Schmiedek, P
AU  - Schmiedek P
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
RN  - 142M471B3J (Carbon Dioxide)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aneurysm, Ruptured/physiopathology/surgery
MH  - Brain/*blood supply
MH  - Brain Ischemia/*diagnosis/physiopathology
MH  - Carbon Dioxide/blood
MH  - Electrodes, Implanted
MH  - Female
MH  - Humans
MH  - Intracranial Aneurysm/physiopathology/*surgery
MH  - Intraoperative Complications/*diagnosis/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Intraoperative/*instrumentation
MH  - Oxygen/blood
MH  - Regional Blood Flow/physiology
MH  - Risk
MH  - Subarachnoid Hemorrhage/physiopathology/surgery
MH  - Surgical Instruments
MH  - Thermodilution/*instrumentation
EDAT- 2001/09/22 10:00
MHDA- 2001/10/05 10:01
CRDT- 2001/09/22 10:00
PHST- 2001/09/22 10:00 [pubmed]
PHST- 2001/10/05 10:01 [medline]
PHST- 2001/09/22 10:00 [entrez]
AID - 10.3171/jns.2001.95.3.0402 [doi]
PST - ppublish
SO  - J Neurosurg. 2001 Sep;95(3):402-11. doi: 10.3171/jns.2001.95.3.0402.