Episodic high irrigation pressure during surgical neuroendoscopy may cause intermittent intracranial circulatory insufficiency.
Episodic high irrigation pressure during surgical neuroendoscopy may cause intermittent intracranial circulatory insufficiency.
复制标题
神经内窥镜手术期间间歇性的高冲洗压力可能会导致间歇性颅内循环不足。
DOI：
10.1097/00008506-200104000-00014
复制
发表时间：
2001
影响因子：
3.7
通讯作者：
E. Ferrer
中科院分区：
文献类型：
--
作者：
N. Fabregas;R. Valero;E. Carrero;J. Tercero;L. Caral;†Elisabeth Zavala;E. Ferrer
在神经内窥镜手术过程中，内窥镜内部的间歇性高峰值压力值与术后发病率相关。意外的苏醒延迟是麻醉师最常观察到的并发症，原因是内窥镜内的峰值压力值很高。在八次神经内窥镜手术中，作者使用固定在患者颞窗上的经颅多普勒 (TCD) 探头连续监测脑血流动力学功能。我们观察到，在神经内窥镜导航冲洗期间，内窥镜内部出现高峰值压力值，导致 TCD 波轮廓的变化与“近颅内停循环”波一致。这些间歇性脑灌注压严重下降并没有伴随全身血流动力学警告信号。当冲洗液逸出后，内窥镜内部的压力下降，TCD 波立即恢复到之前的值。神经内窥镜手术虽然被归类为微创手术，但需要进行特殊监测，以提醒我们脑灌注压的下降。大脑中动脉 TCD 记录是实现此目的的可靠且准确的工具。
Intermittent high peak pressure values inside the endoscope during neuroendoscopic surgical procedures are associated with postoperative morbidity. Unexpected delay in awakening is the complication most frequently observed by the anesthesiologist as a result of high peak pressure values inside the endoscope. During eight neuroendoscopic procedures the authors continuously monitored cerebral hemodynamic function, using a transcranial doppler (TCD) probe fixed on patients' temporal window. We observed that episodes of high peak pressure values inside the endoscope during neuroendoscopic navigation rinsing periods resulted in changes in the TCD wave profile consistent with "near intracranial circulatory arrestlike" wave. No systemic hemodynamic warning signs accompanied these intermittent episodes of severe decrease in cerebral perfusion pressure. When the rinsing liquid was allowed to escape, the pressure inside the endoscope decreased and the TCD wave immediately returned to its previous value. Neuroendoscopic procedures, although classified as minimally invasive surgery, warrant special monitoring that could alert us to a decrease in cerebral perfusion pressure. Middle cerebral artery TCD recording is a reliable and accurate tool for this purpose.