Intraoperative, Real-time Monitoring of Cerebral PtiO2 During a Cerebral Artery Aneurysm Clipping and Simultaneous Electroacupuncture Stimulation

摘要

Background: Partial pressure of cerebral tissue oxygen monitoring (PtiO2), a reliable method of assessing cerebral perfusion, is routinely applied in the Intensive Care Units, but there are only a few reports of intraoperative cerebral PtiO2monitoring in the literature. We present the first case, worldwide, of intraoperative, real-time monitoring of cerebral PtiO2during the surgical clipping of a ruptured cerebral aneurysm and simultaneous electroacupuncture (EA) stimulation.Material & methods: A 69-year-old woman with subarachnoid hemorrhage due to rupture of an anterior communicatingartery aneurysm, underwent surgical clipping of her aneurysm. During the operation, we performed real-time monitoring ofcerebral PtiO2 using a polarographic microcatheter, inserted in the frontal lobe. At a certain time during the operation EAstimulation was performed and we evaluated in real-time its effects on cerebral PtiO2 (acupuncture needles had beenplaced at the beginning of the operation in acupuncture points LU10, PC6, LI4, LI10, GB20, ST36 and SP6 all bilaterally). EAstimulation (2Hz) was administered between LI4 - LI10 and ST36 e SP6 on each side.Results: Cerebral PtiO2 values were recorded until the end of the operation. Initial value recorded was 3,5mmHg (indicativeof cerebral hypoxia due to subarachnoid hemorrhage-induced vasospasm). A few minutes later, EA stimulation was performed for 5 minutes. Right after the onset of EA stimulation cerebral PtiO2 value increased to 9,6mmHg (which is stillbelow normal but nearly 3-fold the initial value before EA stimulation). This immediate effect of EA continued for the entire5 minutes of stimulation and for several minutes after its discontinuation.Conclusion: Intraoperative EA could play a vital role in preserving cerebral blood flow and consequently cerebral PtiO2 inpatients exhibiting brain hypoxia/ischaemia and, thus, prevent irreversible neuronal damage and lead to an improvedneurologic outcome.