Prediction of late ischemic complications after cerebral aneurysm surgery by the intraoperative measurement of cerebral blood flow

Abstract

The response of cerebral blood flow (CBF) to drug-induced hypotension was measured in 20 patients who underwent craniotomy for clipping of a cerebral aneurysm following subarachnoid hemorrhage. A modified intravenous xenon-133 injection technique was used to monitor CBF. In 15 patients, CBF increased significantly with hypotension, and only one developed a late neurological deficit. In five patients, CBF fell with halothane-induced hypotension, and four developed delayed neurological deficits. Measurement of the intraoperative CBF response to halothane-induced hypotension may reveal those patients at greatest risk of developing late neurological deficits and who require more intensive postoperative monitoring and early use of the induced hypertension technique.

Impairment of Cerebral Autoregulation Predicts Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

“…These findings support the hypothesis that cerebral autoregulation plays an important role in the development of cerebral ischemia. [5][6][7][8][9][10]25,26 It has been previously demonstrated, 14,15 and here we confirmed, that autoregulation can be reliably determined using noninvasive techniques based on TCD, as well as NIRS. Furthermore, the results indicate significant colinearity between TCD-and NIRS-based assessment of cerebral autoregulation.…”

“…[5][6][7][8][9][10][11]25 However, the small numbers, inclusion of only poor grade SAH patients, use of invasive monitoring techniques, and univariate analysis did not allow for wide generalization. Nevertheless, it has been shown that early dysautoregulation is predictive of poor outcome.…”

“…2,3 Studies have demonstrated that disturbed cerebral autoregulation may play a part in the development of DCI and promote poor outcome. [4][5][6][7][8][9][10][11] The ability to compensate for the reduced perfusion pressure distal to spastic vessels may be reduced when autoregulatory mechanisms are impaired, [4][5][6][7][8][9] suggesting that accurate detection of dysautoregulation could identify patients at risk of DCI.…”

Carbon dioxide reactivity during prostaglandin E1. induced hypotension for cerebral aneurysm surgery

“…[3][4][5] reported that there was a risk of postoperative neurological deficit in patients with impaired autoregulation. 6 Several intravenous drugs such as trimethaphan (TMP), nitroglycerine (TNG), adenosine and sodium nitroprusside (SNP) have been used to induce hypotension but it is difficult to identify a preferable drug.…”

Cerebral Autoregulation after Subarachnoid Hemorrhage: Comparison of Three Methods

“…It has been described that cerebral autoregulation may become disturbed after subarachnoid hemorrhage (SAH), [1][2][3][4][5][6][7] which has been associated with development of delayed cerebral ischemia (DCI). 1,2,[5][6][7][8][9] The transient hyperemic response test (THRT) is a transcranial Doppler (TCD) based method, which characterizes the changes in cerebral blood flow velocity (FV) after a brief compression of the common carotid artery. It is a recognized and simple method of testing autoregulation in vivo.…”