Artikel
Intraoperative vascular neuromonitoring in patients with subarachnoid hemorrhage: preliminary results and predicitive value of combined laser-Doppler spectrophotometry
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Veröffentlicht: | 8. Juni 2016 |
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Objective: Intraoperative real-time monitoring of cerebral blood flow and tissue oxygenation in patients with subarachnoid hemorrhage (SAH) might be of predicitive value concerning the postoperative neurological status and course of the disease. Using a novel non-invasive measurement technique, we studied local cerebral microcirculation and correlated intraoperative recordings with patient outcome.
Method: We used the laser-Doppler spectrophotometry system „Oxygen-to-see(O2C)“ in 10 consecutive patients with SAH Hunt & Hess grade 2 to 5 who underwent microsurgical clipping of associated cerebral aneurysms. A fiber optic subdural probe recorded capillary venous oxygenation (SO2), post-capillary venous filling pressures (rHb), blood cell velocity (velo) and blood flow (flow) in 7 mm tissue depth. Data samples were taken immediately before dural closure with a sample size of 30 seconds. Additionally, we recorded somatosensory evoked potentials (SEP) with median and tibial nerve stimulation. Results were compared to neurological performance at the day of discharge from hospital.
Results: Five patients with SAH grade 4 and 5 had an median increase of SO2 by 39 % (2-146%), rHb by 11% (1-26%), whereas velo and flow decreased by 28% (18%-53%) and 31% (14%-71%), respectively. These changes in microcirculatory parameters indicated hypoperfusion and cerebral edema matching SEP changes of latency and amplitude of N20 or P40 waves as well as cranial CT pathologies and postoperative neurological deterioration. Measured microcirculatory values of the remaining 5 patients (SAH grade 2 and 3) improved during the course of surgery, resulting in a better functional outcome.
Conclusions: Using intraoperative laser-Doppler spectrophotometry, we demonstrated the potential predictive value of this technique regarding postoperative clinical outcome in a small patient cohort. Interestingly, patients with SAH 2 and 3 experienced minor neurological deficits, which corresponded to recovery of microcirculatory parameters during intraoperative measurement.