Regional Cerebral Oxygen Saturation Changes After Decompressive Craniectomy for Malignant Cerebral Venous Thrombosis: A Prospective Cohort Study

Venkateswaran, Pavithra; Sriganesh, Kamath; Chakrabarti, Dhritiman; Srinivas, Deepti; Gs, Rao

doi:10.1097/ana.0000000000000498

Cited by 12 publications

(10 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Such treatment cannot prevent brain herniation. DC removes the immediate threat of herniation, improves cortical collateral venous drainage leading to a reduction in intracranial pressure, and improves regional cerebral oxygen saturation and, generally, CVST patients who undergo DC do better than ischemic stroke patients as the main pathology is oedema rather than ischemia and their brains can recover completely [12][13][14].…”

Section: Decompressive Craniectomy Technique and Rationalementioning

confidence: 99%

Role, Effectiveness, and Outcome of Decompressive Craniectomy for Cerebral Venous and Dural Sinus Thrombosis (CVST): Is Surgery Really an Option?

Mohamed

Aung

Mereddy

et al. 2020

Cureus

View full text Add to dashboard Cite

Section: Decompressive Craniectomy Technique and Rationalementioning

confidence: 99%

Role, Effectiveness, and Outcome of Decompressive Craniectomy for Cerebral Venous and Dural Sinus Thrombosis (CVST): Is Surgery Really an Option?

Mohamed

Aung

Mereddy

et al. 2020

Cureus

View full text Add to dashboard Cite

“…Table 1 shows studies (2012 till the present) which evaluated the role of DC in CVST. Most of the single-center, high-volume studies were published from low-to-middle income countries, and includes two from the author's institution [see Table 1; (35, 37)] and it reflects the prevalence of uncorrected nutritional anemia and deficient perinatal care in general. Though endovascular services are available at the author's institution, DC was often required because the majority of the patients presented with impending herniation where the role of thrombolysis was limited.…”

Section: Decompressive Craniectomy In Cvstmentioning

confidence: 99%

Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis

Avanali¹,

Gopalakrishnan

Devi

et al. 2019

Front. Neurol.

View full text Add to dashboard Cite

Cerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke more often affecting women and younger individuals. Blockage of the venous outflow rapidly causes edema and space-occupying venous infarctions and it seems intuitive that decompressive craniectomy (DC) can effectively reduce intracranial pressure just like it works for malignant middle cerebral artery infarcts and traumatic brain injury. But because of the relative rarity of this type of stroke, strong evidence from randomized controlled trials that DC is a life-saving procedure is not available unlike in the latter two conditions. There is a possibility that other forms of interventions like endovascular recanalization, thrombectomy, thrombolysis, and anticoagulation, which cannot be used in established middle cerebral artery infarcts and TBI, can reverse the ongoing pathology of increasing edema in CVST. Such interventions, although presently unproven, could theoretically obviate the need for DC when used in early stages. However, in the absence of such evidence, we recommend that DC be considered early as a life-saving measure whenever there are large hemorrhagic infarcts, expanding edema, radiological, and clinical features of impending herniation. This review gives an overview of the etiology and risk factors of CVST in different patient populations and examines the effectiveness of DC and other forms of interventions.

show abstract

“…In recent years, with the development of medical monitoring equipment, regional cerebral oxygen saturation (rSO 2 ) monitoring technology [15,16] has been gradually developed and used in clinical anesthesia. It provides a condition for real-time monitoring of the perfusion level of brain tissue in patients undergoing craniotomy and provides technical support for carrying out clinical research on protective pulmonary ventilation during craniotomy.…”

Section: Introductionmentioning

confidence: 99%

The effects of protective lung ventilation on regional cerebral oxygen saturation in intracranial tumor operation during dura opening: study protocol for a randomized controlled trial

Liu

et al. 2020

Trials

View full text Add to dashboard Cite

Objective: The objective of this trial is to investigate the effects of protective lung ventilation on regional cerebral oxygen saturation (rSO 2 ) during dura opening, that is from Ta (after dura opening) to Tb (before dura closing), in patients undergoing intracranial tumor surgery. Methods: This is a randomized controlled trial which will be carried out at the Second Affiliated Hospital of Soochow University. Fifty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group (C group) or the protective lung ventilation group (P group). In the C group, the tidal volume (VT) will be set at 8 ml/kg of predicted body weight, but positive end-expiratory pressure (PEEP) and recruitment maneuvers will not be used. In the P group, VT will be set at 6 ml/kg of predicted body weight combined with individualized PEEP during dura opening, while in other periods of general anesthesia, VT will be set at 8 ml/kg of predicted body weight. The level of rSO 2 , partial pressures of oxygen and carbon dioxide, oxygenation index, lactic acid level in arterial blood, and mean arterial pressure will be compared before anesthesia (T0), before dura opening (T1), after dura closing (T2), and 24 h after surgery (T3). Lung ultrasound scores will be measured at T0 and T3. The degree of brain relaxation at T1 and T2 will be evaluated by the surgeon using the brain relaxation scale. The amount of vasoactive drugs used and blood loss will be recorded during surgery. The duration of operation and reoperation rate will be recorded. The primary outcome of this study is the changes in rSO 2 within 24 h postoperatively.Discussion: This study aims to determine whether protective lung ventilation during dura opening can improve rSO 2 and the state of pulmonary ventilation in patients undergoing intracranial tumor surgery, and to investigate whether this strategy affects the degree of brain tissue swelling and the reoperation rate after operation. If our results are positive, this study will show that protective lung ventilation during dura opening can be used effectively and safely in neurosurgical patients undergoing craniotomy for tumor resection.

show abstract

Regional Cerebral Oxygen Saturation Changes After Decompressive Craniectomy for Malignant Cerebral Venous Thrombosis: A Prospective Cohort Study

Abstract: Patients with malignant CVT had a lower rSO2 on ipsilateral side of the lesion, which improved significantly after DC. Preoperative rSO2 was not correlated with the duration of hospital stay.

Cited by 12 publications

References 17 publications

Role, Effectiveness, and Outcome of Decompressive Craniectomy for Cerebral Venous and Dural Sinus Thrombosis (CVST): Is Surgery Really an Option?

Role, Effectiveness, and Outcome of Decompressive Craniectomy for Cerebral Venous and Dural Sinus Thrombosis (CVST): Is Surgery Really an Option?

Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis

The effects of protective lung ventilation on regional cerebral oxygen saturation in intracranial tumor operation during dura opening: study protocol for a randomized controlled trial

Contact Info

Product

Resources

About