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ULTIMO FASCICOLOJOURNAL OF NEUROSURGICAL SCIENCES

Rivista di Neurochirurgia

Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651

Periodicità: Bimestrale

ISSN 0390-5616

Online ISSN 1827-1855

 

Journal of Neurosurgical Sciences 1999 Giugno;43(2):99-105

 ORIGINAL ARTICLES

Auto­reg­u­la­tion of cor­ti­cal ­blood ­flow dur­ing sur­gery ­for rup­tured intra­cra­ni­al aneu­rysms

Cossu M. 1, Gennaro S. 1, Rossi A. 2, Balestrero M. A. 2, Cella F. 2, Viale G. L. 1

1 Depart­ment of Neu­ro­sur­gery, Uni­ver­sity of ­Genoa Med­i­cal ­School, ­Genoa, Ita­ly;
2 Department of Anaesthe­sio­lo­gy, Uni­ver­sity of ­Genoa Med­i­cal ­School, ­Genoa, Ita­ly

Back­ground. Lit­tle infor­ma­tion is avail­able ­about ­the ­extent ­and ­the ­time ­course of pos­sible impair­ment of cere­bral cir­cu­la­tion occur­ring ­after aneu­rys­mal sub­arach­noid hae­mor­rhage (­SAH). ­The ­aim of ­this ­study ­was to cor­re­late cere­bral auto­reg­u­la­tion, neu­ro­log­i­cal impair­ment at sur­gery ­and tim­ing of sur­gery in ­patients ­with rup­tured intra­cer­e­bral aneu­rysms.
Meth­ods. Cor­ti­cal ­blood ­flow (­CoBF) ­was meas­ured intra­op­er­a­tive­ly by a ther­mal dif­fu­sion ­probe in 77 ­patients dur­ing sur­gery ­for rup­tured supra­ten­to­ri­al aneu­rysms, ­who ­were oper­at­ed on at dif­fer­ent ­time inter­vals ­after bleed­ing. An auto­reg­u­la­tion ­index (AI), ­expressed as ­the ­ratio ­between ­the ­change in ­CoBF ­and ­the ­change of ­mean arte­ri­al ­blood pres­sure at ­the ­time of ris­ing ­the system­ic ­blood pres­sure ­after occlu­sion of ­the aneu­rysm(s), ­was deter­mined in ­each ­case.
­Results. ­Among ­good-­grade ­patients (­WFNS ­grade I-II), ­those oper­at­ed on ­days 0-2 ­after ­SAH ­had a sig­nif­i­cant­ly bet­ter auto­reg­u­la­to­ry ­response, com­pared ­either ­with ­patients ­who under­went sur­gery on ­days 3-7 ­after bleed­ing (p<0.01), or ­with ­those ­whose aneu­rysm ­was occlud­ed ­more ­than 7 ­days ­after rup­ture (p<0.03). ­The ­mean AI of ­poor-­grade ­patients (­WFNS ­grade IV-V), ­who ­received sur­gery on ­days 0-2 ­after ­SAH, ­was sig­nif­i­cant­ly high­er (p<0.01) com­pared ­with ­the cor­re­spond­ing val­ue of ­good-­grade ­patients. No sig­nif­i­cant dif­fer­ence ­was ­found ­between ­the ­mean ­AIs of ­patients ­who sub­se­quent­ly ­did, or ­did ­not, devel­op symp­to­mat­ic vasos­pasm.
Con­clu­sions. It is con­clud­ed ­that ­good-­grade ­patients oper­at­ed on with­in 48 ­hours ­after bleed­ing ­take advan­tage of a pre­served auto­reg­u­la­to­ry func­tion dur­ing con­trolled hypo­ten­sion.

lingua: Inglese


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