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Real-Time Monitoring of Neurocritical Patients with Diffuse Optical Spectroscopies
Published on: November 19, 2020
Regional variations in brain oxygenation during temporary clipping in aneurysm surgery
P A Silva1, A Cerejo, A Vilarinho
1Department of Neurosurgery, Faculty of Medicine, Hospital S. João, Porto, Portugal.
Neurological Research
|November 14, 2012
Summary
Brain tissue oxygen monitoring (PbtO(2)) during aneurysm surgery reveals significant oxygen drops in MCA and PcomA aneurysms, but not consistently in AcomA cases. Longer clipping times in MCA aneurysms correlated with greater PbtO(2) decreases.
Area of Science:
- Neurosurgery
- Cerebrovascular Surgery
- Neurology
Background:
- Brain tissue oxygen concentration (PbtO(2)) monitoring is crucial for detecting cerebral hypoxemia during aneurysm surgery.
- Previous studies have not fully elucidated how PbtO(2) variations differ based on aneurysm location during temporary clipping.
Purpose of the Study:
- To investigate and compare PbtO(2) changes during temporary clipping in surgeries for anterior communicating artery (AcomA), posterior communicating artery (PcomA) origin, and middle cerebral artery (MCA) aneurysms.
- To establish the relationship between aneurysm location, circulatory interruption duration, and PbtO(2) monitoring outcomes.
Main Methods:
- PbtO(2) was monitored in 41 patients undergoing aneurysm surgery: 10 AcomA, 8 PcomA origin, and 23 MCA bifurcation.
- Temporary clips were applied, and PbtO(2) variations were analyzed concerning the duration and type of circulatory interruption for each aneurysm location.
Main Results:
- Significant PbtO(2) decreases occurred in 31% of temporary clipping periods for AcomA aneurysms.
- In contrast, 100% of temporary clipping applications for PcomA and MCA aneurysms showed significant PbtO(2) decreases.
- MCA aneurysms exhibited a higher amplitude of PbtO(2) decrease with clipping durations of 2 minutes or longer compared to shorter periods.
Conclusions:
- PbtO(2) monitoring reveals distinct patterns of cerebral oxygenation changes during temporary clipping based on aneurysm location.
- Significant PbtO(2) variations were consistently observed in MCA and PcomA origin aneurysms across all temporary circulatory interruptions.
- Frontal monitoring in AcomA aneurysm surgery did not consistently show the significant PbtO(2) variations observed in other regions or aneurysm types.
