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Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability

Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability

Published on: February 23, 2016

Prognostic value of regional cerebral oxygen saturation pre and post decompressive craniectomy in patients with

Rohini M Surve¹, Gayatri Sakrikar¹, Pramod Kalgudi¹

¹Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru, India.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia

|June 22, 2025

Abstract

Background:

Malignant ischemic stroke (MIS) is a life-threatening emergency requiring decompressive craniectomy (DC). Regional cerebral oxygenation (rScO₂) may provide valuable insights during the perioperative period of MIS. Primary objective of this study was to observe the correlation between baseline bilateral rScO₂ (ipsilateral side (rScO₂I) and contralateral side (rScO₂C) with severity of the stroke assessed by National Institutes of Health Stroke Scale score (NIHSS) and Glasgow Coma Scale (GCS), and with discharge and 30 days functional outcome. Secondary objectives were to study the effect of DC on bilateral rScO₂ changes and its correlation with the outcome.

Methods:

This prospective observational study was conducted over a period of one year, and included adult patients of MIS requiring DC. NIHSS and GCS were assessed at admission, before and immediately after surgery. In operation theatre, baseline, during induction and at the end of the surgery, bifrontal rScO₂ were recorded. Patient's outcome was assessed using Glasgow outcome scale extended (GOSE) and modified Rankin Score (mRS) at discharge and 30 days. Data analysed using R version 4.3.2.

Results:

A total of 35 patients were recruited. Baseline rScO₂I values, but not the rScO₂C, significantly correlated with admission GCS (r = 0.457, p = 0.007), and preoperative NIHSS (r = -0.384, p = 0.025). Baseline rScO₂ did not correlate with the outcome. Following DC, significant improvement was observed in rScO₂I (p = 0.03) and rScO₂C (p = 0.02) with changes in rScO₂C, but not rScO₂I, showed a strong positive correlation with discharge GOSE (r = 0.734, p = 0.000) and 30-day GOSE (r = 0.455, p = 0.02), and a negative correlation with discharge (r = -0.641, p = 0.000) and 30-day mRS (r = -0.485, p = 0.01).

Conclusion:

Non-invasive cerebral oxygenation correlates with the severity of stroke, helps to monitor the changes following DC and also to predict the short-term functional outcome, suggesting its utility during the perioperative course in MIS patients.

Keywords:

Cerebral Oxygenation Decompressive Craniectomy Functional Outcome Malignant Cerebral Infarction Near-Infrared Spectroscopy

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