Department of Neuroendovascular Therapy, Tohoku University Graduate School of Medicine, Sendai, Japan.
Neurosurgery. 2011 Sep;69(3):677-88; discussion 688. doi: 10.1227/NEU.0b013e3182195509.
Cerebral blood flow (CBF) is important in the management of cerebrovascular diseases. Surgical manipulation may compromise the appropriate interpretation of postoperative CBF changes, but the effects are not well understood.
To investigate the effect of surgical manipulation on postoperative CBF in a setting of prospective randomized comparison of 2 irrigation fluids during surgery.
Twenty patients undergoing the clipping of unruptured cerebral aneurysms through the pterional approach were randomly assigned to use of Artcereb, an artificial cerebrospinal fluid, or physiological saline as irrigation fluid. Postoperative CBF and clinical conditions were evaluated 3 times in the first 7 to 10 postoperative days.
Postoperative CBF decreased by 10 to 15% on the first postoperative day in the ipsilateral inferior frontal gyrus, where surgical manipulation may be greatest. CBF reduction was less in regions remote from the surgical site and later in the follow-up periods. Selection of irrigation fluid did not influence postoperative CBF significantly, although postoperative clinical conditions may be better using Artcereb.
Postoperative CBF changes due to surgical manipulation should be considered in patients whose hemodynamic conditions are important for appropriate management.
脑血流（CBF）在脑血管疾病的治疗中非常重要。手术操作可能会影响对术后 CBF 变化的正确解读，但目前对其影响还了解不足。
在一项通过翼点开颅夹闭未破裂脑动脉瘤手术中，对比两种冲洗液的前瞻性随机对照研究中，研究手术操作对术后 CBF 的影响。
20 例行翼点开颅夹闭未破裂脑动脉瘤的患者，随机分为使用人工脑脊液 Artcereb 或生理盐水作为冲洗液。术后 7-10 天内，共评估 3 次术后 CBF 和临床情况。
在手术操作可能最大的同侧额下回，术后第 1 天 CBF 降低 10%-15%。远离手术部位和随访后期的 CBF 减少幅度较小。尽管使用 Artcereb 术后临床情况可能更好，但冲洗液的选择对术后 CBF 没有显著影响。
对于那些血流动力学状况对适当治疗很重要的患者，应该考虑手术操作引起的术后 CBF 变化。
