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

Copyright © 1999 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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