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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 January;78(1):34-45
Usefulness and limits of near infrared spectroscopy monitoring during endovascular neuroradiologic procedures
Mazzeo A. T. 1, Di Pasquale R. 1, 4, Settineri N. 2, Bottari G. 1, 5, Granata F. 3, Faragò G. 3, 6, Pitrone A. 3, Longo M. 3, Santamaria L. B. 1 ✉
1 Anesthesia and Neurointensive Care Unit, Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, Italy;
2 Department of Radiotherapy, University of Messina, Messina, Italy;
3 Department of Radiological Sciences, University of Messina, Messina, Italy;
4 Anesthesia and Intensive Care, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy;
5 Anesthesia and Intensive Care, Istituto Giannina Gaslini, Genova, Italy;
6 Department of Radiological Sciences, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy.
BACKROUND: Transcranial cerebral oximetry (TCCO) with near-infrared spectroscopy (NIRS) is a non-invasive, bedside technique, which allows the continuous measurement of regional cerebral oxygenation. The aim of this study was to evaluate TCCO monitoring during endovascular neuroradiologic procedures.
METHODS: Adult patients undergoing elective endovascular embolization of cerebral aneurysms, arteriovenous malformations, dural arteriovenous fistulas and meningiomas under general anesthesia were included in the study, over a period of 12 months. Twenty-eight procedures in 25 patients were analyzed.
RESULTS: Regional cerebral oxygenation rSO2 readings were significantly different according to the different phases of the neuroendovascular procedure. An effect of the underlying cerebral pathology on regional cerebral oxygenation rSO2 recording, in relation to the different stage of the interventional procedure, was also evident, the more invasive the procedure the greater the impact on rSO2 reading. NIRS monitoring contributed to a prompt diagnosis and management of two adverse intraoperative events and helped in early evaluation of prognosis.
CONCLUSION: TCCO with NIRS is a promising monitoring tool to assess the balance between oxygen supply and demand during neuroradiologic procedures. Nevertheless, some limits should be acknowledged, such as the study of the posterior circulation and artefacts related to contrast agent injection. A careful understanding of the undergoing step of the procedure as well of the possible influence of intrinsic and extrinsic factors affecting recording is important for interpretation of data.