Amato Marcelo Campos Moraes, Carneiro Vinicius Marques, Fernandes Denylson Sanches, de Oliveira Ricardo Santos
Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
World Neurosurg. 2023 Nov;179:e557-e567. doi: 10.1016/j.wneu.2023.09.001. Epub 2023 Sep 9.
Neurological complications during full-endoscopic spine surgery (FESS) might be attributed to intracranial pressure (ICP) increase due to continuous saline infusion (CSI). Understanding CSI and ICP correlation might modify irrigation pump usage. This study aimed to evaluate invasive ICP during interlaminar FESS; correlate ICP with irrigation pump parameters (IPPs); evaluate ICP during saline outflow occlusion, commonly used to control bleeding and improve the surgeon's view; and, after durotomy, simulate accidental dural tear.
Five swine were monitored, submitted to total intravenous anesthesia, and positioned ventrally. A parenchymal catheter was installed through a skull burr for ICP monitoring. Lumbar interlaminar FESS was performed until exposure of neural structures. CSI was used within progressively higher IPPs (A [60 mm Hg, 350 mL/minute] to D [150 mm Hg, 700 mL/minute]), and ICP was documented. During each IPP, different situations were grouped: intact dura with open channels (A1-D1) or occlusion test (A2-D2); dural tear with open channels (Ax1-Dx1) or occlusion test (Ax2-Dx2). ICP <20 mm Hg was defined as safe.
Basal average ICP was 8.1 mm Hg. Adjustment in total intravenous anesthesia or suspension of tests was necessary due to critical ICP or animal discomfort. It was safe to operate with all IPPs with opened drainage channels (A1-D1) even with dural tear (Ax1-Dx1). Several occlusion tests (A2-D2, Ax2-Dx2) caused ICP increase (e.g., 86.1 mm Hg) influenced by anesthetic state and hemodynamics.
During FESS, CSI might critically raise ICP. Keeping drainage channels open, with ideal anesthetic state, ICP remains safe even with high IPPs, despite dural tear. Drainage occlusions can quickly raise ICP, being even more severe with higher IPPs. Total intravenous anesthesia may protect from ICP increase and may allow longer drainage occlusion or higher IPPs.
全内镜脊柱手术（FESS）期间的神经并发症可能归因于持续生理盐水输注（CSI）导致的颅内压（ICP）升高。了解CSI与ICP的相关性可能会改变灌洗泵的使用方式。本研究旨在评估椎板间FESS期间的有创ICP；将ICP与灌洗泵参数（IPP）相关联；评估在通常用于控制出血和改善术者视野的生理盐水流出阻塞期间的ICP；以及在硬脊膜切开术后模拟意外硬脊膜撕裂。
对5头猪进行监测，使其接受全静脉麻醉，并采取腹卧位。通过颅骨钻孔安装实质导管以监测ICP。进行腰椎椎板间FESS直至神经结构暴露。在逐渐升高的IPP（A组[60毫米汞柱，350毫升/分钟]至D组[150毫米汞柱，700毫升/分钟]）下使用CSI，并记录ICP。在每个IPP期间，将不同情况分组：硬脊膜完整且通道开放（A1 - D1）或阻塞试验（A2 - D2）；硬脊膜撕裂且通道开放（Ax1 - Dx1）或阻塞试验（Ax2 - Dx2）。ICP <20毫米汞柱被定义为安全。
基础平均ICP为8.1毫米汞柱。由于严重的ICP或动物不适，需要调整全静脉麻醉或暂停试验。即使在硬脊膜撕裂（Ax1 - Dx1）的情况下，所有开放引流通道的IPP操作都是安全的（A1 - D1）。几次阻塞试验（A2 - D2，Ax2 - Dx2）导致ICP升高（例如86.1毫米汞柱），受麻醉状态和血流动力学影响。
在FESS期间，CSI可能会严重升高ICP。保持引流通道开放，在理想的麻醉状态下，即使IPP较高且存在硬脊膜撕裂，ICP仍保持安全。引流阻塞可迅速升高ICP，在较高IPP时更为严重。全静脉麻醉可能防止ICP升高，并可能允许更长时间的引流阻塞或更高的IPP。
