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Blood flow velocity in the middle cerebral artery during transnasal endoscopic skull base surgery performed in controlled hypotension
Affiliations- Department of Otolaryngology, Medical University of Bialystok, Poland
- Department of Neurosurgery, Medical University of Bialystok, Poland
- Department of Anaestesiology, Medical University of Bialystok, Poland
- Department of Cardiosurgery, Medical University of Bialystok, Poland
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Abstract
To assess blood flow velocity in the middle cerebral artery (MCA) during transnasal endoscopic procedures performed with decreased hemodynamic parameters.
Materials and methodsIn 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.
ResultsBlood 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.
ConclusionDuring 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
To assess blood flow velocity in the middle cerebral artery (MCA) during transnasal endoscopic procedures performed with decreased hemodynamic parameters.
Materials and methodsIn 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.
ResultsBlood 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.
ConclusionDuring 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.
Keywords
Cerebral blood flow, Endoscopic surgery, Middle cerebral artery, Hypotension, Transcranial Doppler sonography
About this articleTitle
Blood flow velocity in the middle cerebral artery during transnasal endoscopic skull base surgery performed in controlled hypotension
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
181-187
Page views
222
Article views/downloads
312
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
