gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Continuous measurement of cerebral oxygenation with near infrared spectroscopy (INVOS 5100C) after spontaneous subarachnoid hemorrhage

Meeting Abstract

  • H. Maslehaty - Klinik für Neurochirurgie, Universitätsklinik Schleswig-Holstein, Campus Kiel
  • U.K. Krause-Titz - Klinik für Neurochirurgie, Universitätsklinik Schleswig-Holstein, Campus Kiel
  • H.M. Mehdorn - Klinik für Neurochirurgie, Universitätsklinik Schleswig-Holstein, Campus Kiel

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.09.04

DOI: 10.3205/12dgnc238, URN: urn:nbn:de:0183-12dgnc2382

Published: June 4, 2012

© 2012 Maslehaty et al.
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Outline

Text

Objective: Measurement of regional cerebral oxygen saturation (rSO2) with near infrared spectroscopy (NIRS) is used frequently during cardiac and vascular surgeries. However, continuous measurement for detecting cerebral vasospasm (CVS) after SAH is not done consistently. The aim of our prospective study was to investigate the applicability and the diagnostic value of NIRS in SAH patients using the cerebral oximeter INVOS 5100C (Sommanetics).

Methods: After diagnosis of SAH and following treatment of the bleeding source, self-adhesive oximetry strips were applied bilaterally to the forehead to measure continuously the baseline value of rSO2 in 3 cm depth. Decrease of rSO2 was analyzed and interpreted in view of the determined intrinsic and extrinsic factors (mean arterial blood pressure, hemoglobin, peripheral oxygen saturation, partial carbon dioxide pressure, core temperature, head positioning, correct position and adhesion of the strips). Changes of rSO2 values were matched with the values of intracerebral pressure (ICP), partial brain tissue oxygen saturation (tipO2), transcranial Doppler (TCD) and the results of additional neuro-imaging.

Results: Continuous measurement of rSO2 was performed in nine patients with SAH (7 female, 2 male). Mean measurement time was 8.6 days (range 2–12 days). The clinical course was uneventful in 7 patients without occurrence of CVS. In these patients NIRS measured constant and stable rSO2 values without any decrease in agreement with the values of TCD, ICP and tipO2. Special findings were observed in 2 cases. In one case NIRS detected early a right sided decrease of cerebral oxygenation below the critical value of 45%. TCD showed elevated flow velocities over the middle and anterior cerebral artery, but perfusion-CT scan showed normal patterns. Despite forced triple-H therapy the patient developed a right frontal lobe stroke with increase of ICP. In the other case, TCD showed elevation of flow velocities and DSA showed radiological CVS. However, NIRS showed continuously normal values and the patient developed no CVS related stroke.

Conclusions: Measurement of rSO2 with NIRS is a safe, easy to use, non-invasive additional measurement tool for CVS after SAH and can be applied over a long time period, especially for conscious patients, presumed the involved nursing personnel is instructed. Our study demonstrates the applicability of the INVOS 5100C and the measured values seem to be reliable. However, further large studies are needed to prove our first observations.