Intraoperative monitoring of brain tissue oxygen and carbon dioxide pressure in peritumoural oedema by stereotactic placement of multiparameter microsensors.

摘要

Ischaemia may play an important role in peritumoural brain oedema and swelling, but little data exist so far on brain tissue oxygenation adjacent to a tumour mass. We have monitored brain tissue oxygen tension (ptiO2) and brain tissue CO2 tension (ptiCO2) in 19 patients undergoing craniotomy for resection of a brain tumour using a multiparameter sensor placed in the brain parenchyma. Accurate placement of this probe in the peritumoural area was accomplished with the aid of a 3-D neuronavigation system. Due to various problems we obtained useful data in only 13/19 patients. The presence of brain swelling was associated with a significant rise in ptiO2 upon opening of the dura from 7.1 +/- 7.8 to 23.6 +/- 14.7 mm Hg. The average ptiO2 before tumour resection was 18.1 +/- 10.8 mm Hg. A significant improvement in ptiO2 occurred after tumour resection to an average ptiO2 of 29.7 +/- 15.2 mm Hg. From these preliminary data, we conclude that ptiO2 is depressed in the peritumoural area, and improves following tumour resection. Stereotactic placement of sensors for intraoperative ptiO2 monitoring is feasible and may enhance data quality. Nevertheless, the high incidence of failures with this type of sensor remains a matter of concern.