open access

Vol 48, No 3 (2014)
Original research articles
Submitted: 2014-01-07
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Blood flow velocity in the middle cerebral artery during transnasal endoscopic skull base surgery performed in controlled hypotension

Andrzej Sieskiewicz, Tomasz Lyson, Andrzej Drozdowski, Bartosz Piszczatowski, Robert Rutkowski, Grzegorz Turek, Anna Lewczuk, Marek Rogowski, Zenon Mariak
DOI: 10.1016/j.pjnns.2014.05.006
·
Neurol Neurochir Pol 2014;48(3):181-187.

open access

Vol 48, No 3 (2014)
Original research articles
Submitted: 2014-01-07

Abstract

Background and purpose

To assess blood flow velocity in the middle cerebral artery (MCA) during transnasal endoscopic procedures performed with decreased hemodynamic parameters.

Materials and methods

In 40 patients who underwent endoscopic skull base surgery in controlled hypotension (studied group) and in 13 patients operated without reduction of hemodynamic parameters (control group), blood flow velocity in MCA was assessed with transcranial color Doppler sonography.

Results

Blood flow velocity in MCA remained within the range of age-specific reference values in all patients before operation. It decreased significantly in both groups after induction of anesthesia and then dropped even further in studied group of patients when hemodynamic parameters were reduced; the systolic velocity fell below the normal reference values in 25% of patients, the mean velocity in 50% and the diastolic velocity in 57% of patients. The diastolic velocity was much more heavily influenced by diminished hemodynamic parameters than systolic velocity in the studied group as opposed to the control group where reduction of blood flow velocity pertained equally systolic and diastolic velocity.

Conclusion

During transnasal endoscopic procedures performed in moderate hypotension, in addition to significant drop of blood flow velocity to values well below the normal reference range, a divergent reduction of systolic and diastolic velocity was detected. Since divergent systolic and diastolic velocity may indicate an early phase of cerebral autoregulation compromise, and the decrease of mean blood flow velocity in MCA corresponds with a decrease of cerebral blood flow, further investigations in this field seem warranted.

Abstract

Background and purpose

To assess blood flow velocity in the middle cerebral artery (MCA) during transnasal endoscopic procedures performed with decreased hemodynamic parameters.

Materials and methods

In 40 patients who underwent endoscopic skull base surgery in controlled hypotension (studied group) and in 13 patients operated without reduction of hemodynamic parameters (control group), blood flow velocity in MCA was assessed with transcranial color Doppler sonography.

Results

Blood flow velocity in MCA remained within the range of age-specific reference values in all patients before operation. It decreased significantly in both groups after induction of anesthesia and then dropped even further in studied group of patients when hemodynamic parameters were reduced; the systolic velocity fell below the normal reference values in 25% of patients, the mean velocity in 50% and the diastolic velocity in 57% of patients. The diastolic velocity was much more heavily influenced by diminished hemodynamic parameters than systolic velocity in the studied group as opposed to the control group where reduction of blood flow velocity pertained equally systolic and diastolic velocity.

Conclusion

During transnasal endoscopic procedures performed in moderate hypotension, in addition to significant drop of blood flow velocity to values well below the normal reference range, a divergent reduction of systolic and diastolic velocity was detected. Since divergent systolic and diastolic velocity may indicate an early phase of cerebral autoregulation compromise, and the decrease of mean blood flow velocity in MCA corresponds with a decrease of cerebral blood flow, further investigations in this field seem warranted.

Get Citation

Keywords

Cerebral blood flow, Endoscopic surgery, Middle cerebral artery, Hypotension, Transcranial Doppler sonography

About this article
Title

Blood flow velocity in the middle cerebral artery during transnasal endoscopic skull base surgery performed in controlled hypotension

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 48, No 3 (2014)

Pages

181-187

DOI

10.1016/j.pjnns.2014.05.006

Bibliographic record

Neurol Neurochir Pol 2014;48(3):181-187.

Keywords

Cerebral blood flow
Endoscopic surgery
Middle cerebral artery
Hypotension
Transcranial Doppler sonography

Authors

Andrzej Sieskiewicz
Tomasz Lyson
Andrzej Drozdowski
Bartosz Piszczatowski
Robert Rutkowski
Grzegorz Turek
Anna Lewczuk
Marek Rogowski
Zenon Mariak

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