Soued Mickaël, Le Gouez Agnès, Mercier Frédéric J
From the Service d'Anesthésie, Clinique les Martinets, Groupe Ramsay Santé, Rueil-Malmaison, France.
Département d'Anesthésie, Hôpital Antoine Béclère, APHP.Université Paris-Saclay, Clamart, France.
A A Pract. 2025 Jan 20;19(1):e01908. doi: 10.1213/XAA.0000000000001908. eCollection 2025 Jan 1.
We describe a patient with severe Arnold Chiari Malformation and syringomyelia who underwent gynecological laparoscopy in an emergency context; no brain imaging was available. We here report the successful use of optic nerve sheath diameter (ONSD) and middle cerebral artery (MCA) velocity measurements as surrogate monitoring for cerebral blood flow and intracranial pressure, respectively. MCA velocity was low when assessed after peritoneal insufflation and ONSD increased to 6.3 mm after Trendelenburg positioning. This noninvasive Ultrasound and Doppler neurological monitoring helped adapt the anesthetic management and the patient recovered both normal ONSD and MCA velocity values.
我们描述了一名患有严重阿诺德-奇亚里畸形和脊髓空洞症的患者，该患者在紧急情况下接受了妇科腹腔镜检查；当时没有脑部影像资料。我们在此报告成功使用视神经鞘直径（ONSD）和大脑中动脉（MCA）流速测量分别作为脑血流和颅内压的替代监测指标。气腹后评估时MCA流速较低，头低脚高位后ONSD增加至6.3毫米。这种无创超声和多普勒神经监测有助于调整麻醉管理，患者恢复了正常的ONSD和MCA流速值。
