Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, Paris, France.
Université Paris Cité, Paris, France.
Acta Neurochir (Wien). 2024 Jul 31;166(1):310. doi: 10.1007/s00701-024-06195-8.
Awake surgery is now a common approach for the resection of glioma. One of the surgical complications is mini-stroke which take the form of periresectional small areas of brain ischemic lesions. The main objective of this study is to evaluate the association between factors related to anesthetic management and the risk of mini-stroke, in awake surgery for glioma resection.
In this single-center retrospective study, all patients who were operated on, between 2011 and 2022, in awake conditions for a glioma resection, were retrospectively included. The studied anesthetic parameters included hemodynamic variables, fluid intake and urinary output. The primary endpoint was the presence of mini-stroke on a magnetic resonance imaging performed within the first 48 h postoperatively.
A total of 176 surgeries were included. Mini-stroke was present in 120/171 surgeries (70%), with a median volume of 1.2 interquartile range [0.4-2.2] cubic centimeters (cc). In a multivariable analysis, only the per operative urinary output was significantly associated with the incidence of postoperative mini-strokes (adjusted odd-ratio 0.65, 95% confidence interval 0.45-0.94, p = 0.02). No variables related to the anesthetic management were associated with the volume of postoperative mini-strokes. In particular, the time spent below 90% of the baseline systolic blood pressure was not associated with either the risk or the volume of mini-strokes.
During awake surgery for glioma resection, among several anesthesia related factors, only the per operative urinary output was associated with the incidence of postoperative mini-stroke.
清醒开颅术现已成为切除脑胶质瘤的常用方法。手术并发症之一是迷你中风，其表现为切除部位周围的小面积脑缺血性病变。本研究的主要目的是评估与麻醉管理相关的因素与清醒开颅切除脑胶质瘤手术中小中风风险之间的关联。
本单中心回顾性研究纳入了 2011 年至 2022 年间所有在清醒状态下接受脑胶质瘤切除术的患者。研究的麻醉参数包括血流动力学变量、液体摄入量和尿量。主要终点是术后 48 小时内进行的磁共振成像上是否存在迷你中风。
共纳入 176 例手术。120/171 例（70%）手术存在迷你中风，中位数体积为 1.2 四分位间距 [0.4-2.2] 立方厘米（cc）。多变量分析显示，仅术中尿量与术后迷你中风的发生显著相关（调整后的优势比 0.65，95%置信区间 0.45-0.94，p=0.02）。与麻醉管理相关的变量均与术后迷你中风的体积无关。特别是，收缩压低于基线 90%以下的时间与迷你中风的风险或体积均无关联。
在脑胶质瘤切除的清醒开颅术中，在几个与麻醉相关的因素中，只有术中尿量与术后迷你中风的发生相关。
