Silva P A, Cerejo A, Vilarinho A, Dias C, Vaz R
Department of Neurosurgery, Faculty of Medicine, Hospital S. João, Porto, Portugal.
Neurol Res. 2012 Dec;34(10):971-6. doi: 10.1179/1743132812Y.0000000103.
Brain tissue oxygen concentration (PbtO(2)) monitoring has been used in aneurysm surgery to detect decreased brain oxygenation during temporary clipping. The effects of circulatory interruption according to different aneurysm locations have not been established. In this work, variations in PbtO(2) during temporary clipping were studied in anterior communicating (AcomA), posterior communicating (PcomA) origin, and middle cerebral artery (MCA) aneurysm surgery.
PbtO(2) was monitored during surgery of 41 patients; aneurysms were located in the AcomA (10 cases), origin of PcomA (8 cases), and MCA bifurcation (23 cases). Temporary clips were used in all cases. Variations in PbtO(2) values obtained during application of temporary clips were evaluated and studied according to the duration and type of circulatory interruption for each aneurysm location.
In AcomA aneurysm surgery, a significant decrease in PbtO(2) values was found in 31% of the periods of temporary clipping, whereas in PcomA and MCA aneurysm surgery, significant decreases were found in all temporary clip applications (100%). In MCA aneurysms, the amplitude of decrease in PbtO(2) was higher when the circulatory interruption lasted for 2 or more minutes, compared with shorter periods of temporary clipping.
During temporary clipping, different variations in PbtO(2) values were obtained when comparing frontal and temporal regions of monitoring: in MCA and PcomA origin aneurysms, significant variations were registered in all periods of temporary regional circulatory interruption, but the same results were not found in frontal monitoring for AcomA aneurysm surgery.
脑组织氧浓度（PbtO₂）监测已用于动脉瘤手术，以检测临时夹闭期间脑氧合降低情况。不同动脉瘤位置的循环中断影响尚未明确。在本研究中，我们对前交通（AcomA）、后交通（PcomA）起始部和大脑中动脉（MCA）动脉瘤手术中临时夹闭期间PbtO₂的变化进行了研究。
对41例患者手术期间进行PbtO₂监测；动脉瘤位于AcomA（10例）、PcomA起始部（8例）和MCA分叉处（23例）。所有病例均使用临时夹。根据每个动脉瘤位置的循环中断持续时间和类型，评估并研究临时夹应用期间获得的PbtO₂值变化。
在AcomA动脉瘤手术中，31%的临时夹闭期PbtO₂值显著下降，而在PcomA和MCA动脉瘤手术中，所有临时夹应用期均出现显著下降（100%）。在MCA动脉瘤中，与较短的临时夹闭期相比，循环中断持续2分钟或更长时间时，PbtO₂下降幅度更大。
在临时夹闭期间，比较监测的额叶和颞叶区域时，PbtO₂值出现不同变化：在MCA和PcomA起始部动脉瘤中，所有临时区域循环中断期均记录到显著变化，但在AcomA动脉瘤手术的额叶监测中未发现相同结果。
