Artikel
Analysis of influence of cortex temperature on patient cognition during awake-surgery – a pilot study
Analyse des Einflusses der Kortextemperatur auf die Patientenkognition während einer Wachoperation – Pilotstudie
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Veröffentlicht: | 26. Juni 2020 |
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Objective: During skull trepanning, it is possible to observe an intraoperative heat loss at the brain surface due to convection as well as thermal radiation. This effect is intensified involuntarily, when rinsing fluid adapts to room temperature during surgery, or intentionally, when cerebral seizures are stopped by active ice-water rinsing. However, the patient’s active cognitive cooperation is essential, especially during awake phase. The aim of this pilot study is to investigate the influence of cortex temperature on cognition during awake-surgery.
Methods: During an awake-surgery, the complete course of the cortex’s temperature was analysed continuously by an imaging camera. This was performed with 8 patients at a total of 52 measuring points. The body’s core and the cortical temperature changes were determined over time – split into phases where no water, warm flush (36°C) or ice water was used. As a surrogate for the cognitive performance of patients, a reaction time test was performed intraoperatively on the patient.
Results: During the first measurement the cortex’s temperature was 37.1°C (36.2-37.5°C). The cortex’s surface temperature approached room temperature (median: 26.2°C) without proper regular irrigation (mean - 1.1°C in the first 10 min, mean - 2.4°C in the first 15 min).
Average reaction time was 742 milliseconds. At the same time, average reaction time at a cortex temperature < 35°C was 1421 milliseconds, at a cortex temperature 35°C 572 milliseconds (p < 0.05). At a cortex temperature < 35°C, reaction time improved again after rinsing with warm liquid.
Conclusion: Our pilot study suggests a continuous drop in the cerebral cortex’s temperature during (awake) phase of surgery. Furthermore, the average reaction time correlated with the temperature of the cortex significantly. The brain’s temperature may have significant impact on the cognitive performance of patients during the awake phase. This possible connection should be investigated in further studies.