Impact of cervical internal carotid clamping and radial artery graft bypass on cortical arterial perfusion pressure during craniotomy - Commentary

摘要

Therapeutic cervical internal carotid artery (ICA) occlusion is performed temporarily or permanently in a wide array of neurosurgical procedures such as carotid endarterectomy, treatment of complex carotid aneurysms, and cervical malignant neoplasms. The severity of ischemia during carotid clamping has been assessed during balloon test occlusion (BTO) [4, 9-11, 13, 23, 24, 26, 27, 31, 33, 36]. Previous studies revealed that approximately 15—30 min of occlusion can result in a critical reduction in cerebral blood flow (CBF) in approximately 17-30 % of patients [2, 18, 24]. However, neurological deterioration has also been observed in 3—10 % of patients without immediate neurological symptoms after internal carotid ligation, which can result in severe morbidity and mortality [6, 24].