Artikel
Occurrence of regional ischemia after subarachnoid hemorrhage and implications on placement of tissue oxygenation sensors
Auftreten regionaler Ischämien nach Subarachnoidalblutung und Auswirkungen auf die Platzierung von Gewebssauerstoffpartialdruck-Sonden
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Autoren
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V. Göktas
- Klinik für Neurochirurgie, Klinikum Fulda
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B.M. Hölper
- Klinik für Neurochirurgie, Klinikum Fulda
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M. Janka
- Klinik für Neurochirurgie, Klinikum Fulda
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M. Arndt
- Klinik für Neurochirurgie, Klinikum Fulda
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L. Chone
- Institut für Neuroradiologie, Klinikum Fulda
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R. Martinez
- Klinik für Neurochirurgie, Klinikum Fulda
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R. Behr
- Klinik für Neurochirurgie, Klinikum Fulda
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Vasospasm related ischemia is a frequent major complication after subarachnoid haemorrhage (SAH). Impending ischemia may be detected by local metabolic monitoring (e.g. microdialysis, tissue oxygen tension (ptiO2), local cerebral blood flow) and monitoring would be helpful for indicating promising therapeutic interventions. Until now, there are no guidelines for the placement of local monitoring probes. Therefore, we analysed (1) the appearance of ischemic areas depending on the aneurysm localisation and (2) the localisation of ptiO2 probes due to optimal placement in the region of impending ischemia.
Methods: 89 patients (SAH after aneurysm rupture of the anterior circulation in 87 cases, incidental aneurysms in 2) were further analysed. Clinical status was Hunt&Hess I (HH) in 4 patients, HH II in 21, HH III in 29, HH IV in 23 and HH V in 10. ptiO2 was measured in 31 patients (1 HH1, 5 HH2, 10 HH3, 9 HH4, 5 HH5; 1 incidental aneurysm). Ischemia areas detected in follow-up CT were classified according to vascular territories (A cerebri anterior = ACAT, A. cerebri media = MCAT, A cerebri posterior = PCAT). ptiO2 probes were placed uni- or bilaterally on the frontal cortex (GMS Integra IM1).
Results: ACA/AComA aneurysms: MCAT was affected in 27 patients, while ACAT was affected in 19 patients. Isolated MCAT or combined MCAT/PCAT ischemia was found in 12 patients. In 18 patients, a combined ACA/PCA (n=3) or ACAT/MCAT (n=15) infarction occurred. However, an exclusive ACAT infarction was found in only one patient.
ICA- and MCA aneurysms: ischemic areas in MCAT were found in 8, MCAT/PCAT in 12 and MCAT/ACAT in 15 patients. No isolated ischemia in ACAT or PCAT was found. In 14 patients with ptiO2 probes and ischemia, the probe was placed in the area of the later occurring infarction in only 3 patients.
Conclusions: MCAT is the region of highest risk for cerebral ischemia after SAH in our patients, not only for MCA/ICA aneurysms, but also for ACA/AComA aneurysms. However, conventional frontal localization of metabolic probes results in a very low rate of probes being placed in the area of the later occurring infarction. Therefore, a redefinition of probe placement depending on several risk factors which are currently analyzed should be investigated.
