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Cortical blood flow recorded during early or delayed surgery for ruptured intracranial aneurysms

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Summary

Forty-three patients were operated on for ruptured intracranial aneurysms during a 12-month-period. Intraoperative evaluation of cortical blood flow by means of a thermal diffusion probe was performed in 23 out of the 41 patients who were operated on for aneurysms of the anterior circulation. The autoregulation index was determined at the time of raising the systemic blood pressure after clipping of the aneurysm(s). No statistically significant difference was found between the averages of the autoregulation indexes calculated in the subgroups of patients submitted respectively to early or delayed surgery. There was no correlation of both cortical blood flow and autoregulation with either age of the patients, or preoperative neurological grade. On the contrary, the autoregulation index showed a statistically significant correlation with outcome.

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References

  1. Austrian JI, Diaz FG, Malik GM, Andrews BT, McCormick PW, Balakrishnan G (1989) Management of cerebral aneurysms: further facts and additional myths. Surg Neurol 32: 21–35

    PubMed  Google Scholar 

  2. Bailes JE, Spetzler RF, Madley MN, Baldwin HZ (1990) Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 72: 559–566

    PubMed  Google Scholar 

  3. Barnett GH, Little JR, Ebrahim ZY, Jones SC, Eriel HT (1987) Cerebral circulation during arteriovenous malformation operation. Neurosurgery 20: 836–842

    PubMed  Google Scholar 

  4. Carter LP (1991) Surface monitoring of cerebral cortical blood flow. Cerebrovasc Brain Metab Rev 3: 246–261

    PubMed  Google Scholar 

  5. Carter LP, Erspamer R, Bro WJ (1981) Cortical blood flow: thermal diffusion vs. isotope clearance. Stroke 12: 513–518

    PubMed  Google Scholar 

  6. Carter LP, Erspamer R, White WL, Yamagata S (1982) Cortical blood flow during craniotomy for aneurysm. Surg Neurol 17: 204–208

    PubMed  Google Scholar 

  7. Carter LP, Grahm T, Bailes JE, Bichard W, Spetzler RF (1991) Continuous postoperative monitoring of cortical blood flow and intracranial pressure. Surg Neurol 35: 36–39

    PubMed  Google Scholar 

  8. Carter LP, White AL, Atkinson JR (1978) Regional cortical blood flow at craniotomy. Neurosurgery 2: 223–229

    PubMed  Google Scholar 

  9. Dernbach PD, Little JR, Jones SC, Ebrahim ZY (1988) Altered cerebral autoregulation and CO2 reactivity after aneurysmal subarachnoid haemorrhage. Neurosurgery 22: 822–826

    PubMed  Google Scholar 

  10. Deruty R, Mottolese C, Pelosson-Guyotat I, Bognar L, Oubouklik A (1992) L'anéurysme intracrânien rompu. Modulation de la chirurgie en function de l'état de conscience et de l'âge du patient. Neurochirurgie 38: 9–17

    PubMed  Google Scholar 

  11. Deruty R, Mottolese C, Pelisson-Guyotat I, Soustiel JF (1991) Management of the ruptured intracranial aneurysm. Early surgery, late surgery or modulated surgery? Acta Neurochir (Wien) 113: 1–10

    Google Scholar 

  12. Disney L, Weir B, Grace M (1988) Canadian Nimodipine Study Group. Factors influencing the outcome of aneurysm rupture in poor grade patients: a prospective series. Neurosurgery 23: 1–9

    PubMed  Google Scholar 

  13. Drake CG (1988) Report of the Commitee on Subarachnoid Haemorrhage Grading — WFNS. Neurosurgery 22: 980

    Google Scholar 

  14. Farrar JM, Gamache FW Jr, Ferguson GG, Barker J, Verkey GP, Drake CG (1981) Effects of profound hypotension on cerebral blood flow during surgery for intracranial aneurysms. J Neurosurg 55: 857–864

    PubMed  Google Scholar 

  15. Gilsbach JM, Harders AG (1989) Morbidity and mortality after early aneurysm surgery. A prospective study with nimodipine prevention. Acta Neurochir (Wien) 96: 1–7

    Google Scholar 

  16. Grubb RL Jr, Raichle ME, Eichling JO, Gado MH (1977) Effects of subarachnoid haemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J Neurosurg 46: 446–453

    PubMed  Google Scholar 

  17. Handa Y, Hyashi M, Takeuchi H, Kubota T, Kobayashi H, Kawano H (1992) Time course of the impairment of cerebral autoregulation during chronic cerebral vasospasm after subarachnoid hemorrhage in primates. J Neurosurg 76: 493–501

    PubMed  Google Scholar 

  18. Hassler W, Chioffi F (1989) CO2 reactivity of cerebral vasospasm after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 98: 167–175

    Google Scholar 

  19. Isbii R (1979) Regional cerebral blood flow in patients with ruptured intracranial aneurysms. J Neurosurg 50: 587–594

    PubMed  Google Scholar 

  20. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484

    PubMed  Google Scholar 

  21. Kawamura Sh, Sayama I, Yasui N, Uemura K (1992) Sequential changes in cerebral blood flow and metabolism in patients with subarachnoid haemorrhage. Acta Neurochir (Wien) 114: 12–15

    Google Scholar 

  22. Kotb MMW, Symon L, Compton J, Rosenstein J, Jabre A (1991) Grading and outcome prediction of cases of aneurysmal subarachnoid haemorrhage by bedside Xenon cerebral blood flowmetry. Acta Neurochir (Wien) 108: 1–6

    Google Scholar 

  23. Koshu K, Hirota S, Sonobe M, Takakashi S, Takaku A, Saito T, Ushijima T (1987) Continuous recording of cerebral blood flow by means of a thermal diffusion method using a Peltier stack. Neurosurgery 21: 693–698

    PubMed  Google Scholar 

  24. Lazorthes Y, Lagarrigue F (1978) Surveillance pré-opératoire du débit sanguin cérebral lors d'une hypotension artérielle controlee. Neurochirurgie 24: 170–176

    PubMed  Google Scholar 

  25. Martin NA, Carter LP, Spetzler RF (1985) Management of regional cerebral blood flow in aneurysm surgery. Clin Neurosurg 32: 79–104

    PubMed  Google Scholar 

  26. Matsuda M, Shiimo A, Handa J (1990) Sequential changes of cerebral blood flow after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 105: 98–106

    Google Scholar 

  27. Messeter K, Brandt L, Ljunggren B, Svendgaard NA, Algotsson L, Romner B, Ryding E (1987) Prediction and prevention of delayed ischaemic dysfunction after aneurysmal subarachnoid haemorrhage and early operation. Neurosurgery 20: 548–553

    PubMed  Google Scholar 

  28. Meyer CHA, Lowe D, Meyer M, Richardson PL, Neil-Dwyer G (1983) Progressive change in cerebral blood flow during the first three weeks after subarachnoid haemorrhage. Neurosurgery 12: 58–76

    PubMed  Google Scholar 

  29. Nornes H, Knutzen AB, Wikeby P (1977) Cerebral arterial blood flow and aneurysm surgery. Part 2: induced hypotension and autoregulatory capacity. J Neurosurg 47: 819–827

    PubMed  Google Scholar 

  30. Pickard JD, Matheson M, Patterson J, Wyper DJ (1980) Prediction of late ischaemic complications after cerebral aneurysm surgery by the intraoperative measurement of cerebral blood flow. J Neurosurg 53: 305–308

    PubMed  Google Scholar 

  31. Rasmussen G, Hauerbey J, Waldemar G, Gjenis F, Juhler M (1992) Cerebral blood flow autoregulation in experimental subarachnoid haemorrhage in rat. Acta Neurochir (Wien) 119: 128–133

    Google Scholar 

  32. Romner B, Brandt L, Berntman L, Algotsson L, Ljunggren B, Messeter K (1991) Simultaneous transcranial Doppler sonography and cerebral blood flow measurements of cerebrovascular CO2-reactivity in patients with aneurysmal subarachnoid haemorrhage. Br J Neurosurg 5: 31–37

    PubMed  Google Scholar 

  33. Scarda G (1991) Trattamento con nimodipina. Studio clinico prospettico. Italfarmaco SpA, Milano, Italy, pp 1–6

    Google Scholar 

  34. Seifert V, Trost MA, Stolke D (1990) Management morbidity and mortality in grade IV and V patients with aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 103: 5–10

    Google Scholar 

  35. Shiokawa Y, Aoki N, Saito I (1989) Timing of aneurysm surgery. Letter. J Neurosurg 70: 813

    PubMed  Google Scholar 

  36. Solomon RA, Fink ME, Lermihan L (1988) Early aneurysm surgery and prophylactic hypervolemic hypertensive therapy for the treatment of aneurysmal subarachnoid haemorrhage. Neurosurgery 23: 699–704

    PubMed  Google Scholar 

  37. Tenjin H, Hirakawa K, Mizukawa N, Yano I, Ohta T, Uchibori M, Hino A (1988) Dysautoregulation in patients with ruptured aneurysms: cerebral blood flow measurements obtained during surgery by a temperature-controlled thermoelectrical method. Neurosurgery 23: 705–709

    PubMed  Google Scholar 

  38. Voldby B, Enevoldsen EM, Jensen FT (1985) Regional CBF, intraventricular pressure, and cerebral metabolism in patients with ruptured intracranial aneurysms. J Neurosurg 62: 48–58

    PubMed  Google Scholar 

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Viale, G.L., Cossu, M., Cella, F. et al. Cortical blood flow recorded during early or delayed surgery for ruptured intracranial aneurysms. Acta neurochir 131, 1–5 (1994). https://doi.org/10.1007/BF01401447

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