Spinal Cord Perfusion Pressure After Resection of Intramedullary Spinal Cord Tumors

Introduction Surgical resection of intramedullary spinal cord tumors (IMSCTs) involves direct, albeit controlled, trauma to spinal cord tissue. Postoperative management after resection of IMSCTs can include elevated mean arterial pressure (MAP) to augment blood flow to the injured cord. We measured postoperative spinal cord perfusion pressure (SCPP) in five consecutive IMSCT cases and reviewed postoperative hemodynamic management in a continuous, single-surgeon series. Methods This study was conducted at Rush University Medical Center, Chicago, Illinois. All IMSCT patients who underwent surgical resection by the senior author over a 15-year period were reviewed. We reviewed all practices regarding postoperative MAP goals, vasopressor administration, and intensive care unit (ICU) stay. In five consecutive cases, we transduced intrathecal pressure (ITP) via lumbar drain (LD) to calculate SCPP (SCPP = MAP - ITP). Results Thirty-eight patients were reviewed. Twenty-nine patients were managed with postoperative MAP goals (76.3%) for 3.0 ± 1.4 days, with 2.5 ± 1.7 days in the ICU. Twelve patients required pressor administration (31.6%) for 0.9 ± 1.5 days. All patients with SCPP measurement had elevated MAP goals postoperatively, and 4 of 5 required pressor administration. Daily average ITP was normal for the duration of measurement; the highest ITP was measured postoperative days 0 and 1. All patients maintained normal (and significantly elevated) SCPP. Conclusions SCPP is maintained after resection of IMSCT tumors, primarily due to low ITP. Postoperative elevated MAP goals may be unnecessary, so long as normotension is maintained. Future prospective studies with correlated clinical outcomes are needed to confirm this principle.