Intraoperative monitoring of substrate delivery during aneurysm and hematoma surgery: Initial experience in 16 patients

Egon M.R. Doppenberg, Joe C. Watson, William C. Broaddus, Kathryn L. Holloway, Harold F. Young, Ross Bullock

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

The effects of proximal occlusion of the parent artery daring aneurysm surgery in humans are not fully understood, although this method is widely used. The reduction in substrate that can be tolerated by normal and subarachnoid hemorrhage (SAH)-affected brain is unknown. Therefore, the authors measured brain oxygen tension (brain PO2), carbon dioxide tension (brain PCO2), pH, and hemoglobin oxygen (HbO2) saturation before and after temporary occlusion in 12 patients with aneurysms. The effect of removal of a traumatic intracranial hematoma on cerebral oxygenation was also studied in four severely head injured patients. A multiparameter sensor was placed in the cortex of interest and locked by means of a specially designed skull bolt. The mean arterial blood pressure, inspired O2 fraction, and end-tidal PCO2 were analyzed. Brain PO2 and HbO2 saturation data were collected every 10 seconds. Descriptive and nonparametric analyses were used to analyze the data. A wide range in baseline PO2 was seen, although a decrease from baseline in brain PO2 was found in all patients. During temporary occlusion, brain PO2 in patients with unruptured aneurysm (seven patients) dropped significantly, from 60 ± 31 to 27 ± 17 mm Hg (p < 0.05). In the SAH group (five patients), the brain PO2 dropped from 106 ± 74 to 87 ± 73 mm Hg (not significant). Removal of intracranial hematomas in four severely head injured patients resulted in a significant increase in brain PO2, from 13 ± 9 to 34 ± 13 mm Hg (p < 0.05). The duration of safe temporary occlusion could not be determined from this group of patients, because none developed postoperative deterioration in their neurological status. However, the data indicate that this technique is useful to detect changes in substrate delivery during intraoperative maneuvers. This study also reemphasizes the need for emergency removal of intracranial hematomas to improve substrate delivery in severely head injured patients.

Original languageEnglish (US)
Pages (from-to)809-816
Number of pages8
JournalJournal of neurosurgery
Volume87
Issue number6
DOIs
StatePublished - Dec 1997

Keywords

  • Aneurysm
  • Brain oxygen
  • Intracranial hematoma
  • Temporary arterial occlusion

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Fingerprint Dive into the research topics of 'Intraoperative monitoring of substrate delivery during aneurysm and hematoma surgery: Initial experience in 16 patients'. Together they form a unique fingerprint.

  • Cite this

    Doppenberg, E. M. R., Watson, J. C., Broaddus, W. C., Holloway, K. L., Young, H. F., & Bullock, R. (1997). Intraoperative monitoring of substrate delivery during aneurysm and hematoma surgery: Initial experience in 16 patients. Journal of neurosurgery, 87(6), 809-816. https://doi.org/10.3171/jns.1997.87.6.0809