Abstract
Purpose
To describe an episode of acute jugular venous desaturation during intraoperative rupture of a cerebral aneurysm.
Clinical features
A 57-yr-old patient was scheduled for clipping of a large unruptured basilar tip aneurysm. Abrupt bulging of the brain was observed after bone flap removal, but before dura was opened. This was associated with concurrent development of systemic hypertension to 200/120 mmHg and jugular venous bulb (SjvO2) desaturation to 13%. Rupture of aneurysm was confirmed by frank blood in cerebrospinal fluid drainage from the lumbar subarachnoid catheter.
Conclusions
Abrupt SjvO2 desaturation prior to dural opening may suggest an acute increase in intracranial pressure, which in our case followed aneurysmal rupture; the systemic response to increased intracranial pressure (Cushing’s response) may be ineffective in maintaining cerebral perfusion.
Résumé
Objectif
Décrire un épisode de désaturation aiguë de la veine jugulaire pendant la rupture peropératoire ďun anévrysme cérébral.
Éléments cliniques
Un patient de 57 ans devait subir la ligature ďun important anévrysme non rupturé de la pointe basilaire. Un bombement soudain du cerveau a été observé après le retrait du volet osseux mais avant ľouverture de la dure-mère. Une hypertension générale à 200/120 mmHg s’est développée concurremment ainsi qu’une désaturation à 13 % du golfe de la jugulaire (SjvO2). La rupture de ľanévrysme a été confirmée par la présence franche de sang dans le liquide céphalo-rachidien décelée par le cathéter lombaire sous-arachnoïdien.
Conclusion
La désaturation soudaine de la SjvO2 avant ľouverture de la dure-mère peut évoquer une hausse soudaine de la pression intracrânienne, faisant suite à une rupture anévrysmale; la réponse généralisée à ľhypertension intracrânienne (réaction de Cushing) peut être inefficace à maintenir la perfusion cérébrale.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Gunn HC, Matta BF, Lam AM, Mayberg TS. Accuracy of continuous jugular bulb venous oximetry during intracra- nial surgery. J Neurosurg Anesthesiol 1995; 7: 174–7.
Batjer H, Samson D. Intraoperative aneurysmal rupture: incidence, outcome, and suggestions for surgical management. Neurosurgery 1986; 18: 701–7.
Matta BF, Lam AM, Mayberg TS, Shapira Y, Winn HR. A critique of the intraoperative use of jugular venous bulb catheters during neurosurgical procedures. Anesth Analg 1994; 79: 745–50.
Cushing H. Some experimental and clinical observations concerning states of increased intracranial tension. Am J Med Sci 1902; 124: 375–400.
Plets C. Arterial hypertension in neurosurgical emer- gencies. Am J Cardiol 1989; 63: 40C-2C.
van Loon J, Shivalkar B, Plets C, Goffin J, Tjandra-Maga TB, Flameng W. Catecholamine response to a gradual increase of intracranial pressure. J Neurosurg 1993; 79: 705–9.
Ogilvy CS, DuBois AB. Effect of increased intracranial pressure on blood pressure, heart rate, respiration and catecholamine levels in neonatal and adult rabbits. Biol Neonate 1987; 52: 327–36.
Kocsis B, Fedina L, Pasztor E. Effect of preexisting brain ischemia on sympathetic nerve response to intra- cranial hypertension. J Appl Physiol 1991; 70: 2181–7.
Pasztor E, Fedina L, Kocsis B, Berta Z. Activity of peripheral sympathetic efferent nerves in experimental subarachnoid haemorrhage. Part I: observations at the time of intracranial hypertension. Acta Neurochir (Wien) 1986; 69: 125–31.
Rosner MJ, Newsome HH, Becker DP. Mechanical brain injury: the sympathoadrenal response. J Neurosurg 1984; 61: 76–86.
Shivalkar B, Van Loon J, Wieland W, {eaet al.} Variable effects of explosive or gradual increase of intracra- nial pressure on myocardial structure and function. Circulation 1993; 87: 230–9.
Shrader H, Hall C, Zwetnow NN. Effects of prolonged supratentorial mass expansion on regional blood flow and cardiovascular parameters during the Cushing response. Acta Neurol Scand 1985; 72: 283–94.
Marshman LA. Cushing’s “variant” response (acute hypotension) after subarachnoid hemorrhage. Association with moderate intracranial tensions and subacute cardiovascular collapse. Stroke 1997; 28: 1445–50.
Fitch W, McDowall DG, Keaney NP, Pickerodt VW. Systemic vascular responses to increased intracranial pressure. 2. The “ushing “ response in the presense of intracranial space-occupying lesions: systemic and cerebral haemodynamic studies in the dog and the baboon. J Neurol Neurosurg Psychiatry 1977; 40: 843–52.
Shalit MN, Cotev S. Interrelationship between blood pressure and regional cerebral blood flow in experimental intracranial hypertension. J Neurosurg 1974; 40: 594–602.
Brinker T, Seifert V, Dietz H. Cerebral blood flow and intracranial pressure during experimental subarachnoid haemorrhage. Acta Neurochir (Wien) 1992; 115: 47–52.
Harris AP, Helou S, Traystman RJ, Jones MDJr,Koehler RC. Efficacy of the Cushing response in maintaining cerebral blood flow in premature and near-term fetal sheep. Pediatr Res 1998; 43: 50–6.
Barbiro-Michaely E, Mayevsky A. Effects of elevated ICP on brain function: can the multiparametric monitoring system detect the ‘Cushing Response’? Neurol Res 2003; 25: 42–52.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rozet, I., Newell, D.W. & Lam, A.M. Intraoperative jugular bulb desaturation during acute aneurysmal rupture. Can J Anesth 53, 97–100 (2006). https://doi.org/10.1007/BF03021535
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03021535