Vol 48, No 3 (2014)

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

Andrzej Sieskiewicz1, Tomasz Lyson2, Andrzej Drozdowski3, Bartosz Piszczatowski1, Robert Rutkowski2, Grzegorz Turek2, Anna Lewczuk4, Marek Rogowski1, Zenon Mariak2
DOI: 10.1016/j.pjnns.2014.05.006
Neurol Neurochir Pol 2014;48(3):181-187.


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.


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.


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.

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Neurologia i Neurochirurgia Polska