Intraoperative monitoring of cerebrospinal fluid gas tension and pH before and after surgical revascularization for moyamoya disease.

Autor: Kuroda S; Department of Neurosurgery, University of Toyama, Toyama, Japan., Yamamoto S; Department of Neurosurgery, University of Toyama, Toyama, Japan., Hori E; Department of Neurosurgery, University of Toyama, Toyama, Japan., Kashiwazaki D; Department of Neurosurgery, University of Toyama, Toyama, Japan., Noguchi K; Department of Radiology, University of Toyama, Toyama, Japan.
Jazyk: angličtina
Zdroj: Surgical neurology international [Surg Neurol Int] 2024 May 10; Vol. 15, pp. 158. Date of Electronic Publication: 2024 May 10 (Print Publication: 2024).
DOI: 10.25259/SNI_281_2024
Abstrakt: Background: This study aimed to directly measure cerebrospinal fluid (CSF) gas tensions and pH before and after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis for moyamoya disease.
Methods: This study included 25 patients with moyamoya disease who underwent STA-MCA anastomosis combined with indirect bypass onto their 34 hemispheres. About 1 mL of CSF was collected before and after bypass procedures to measure CSF partial pressure of oxygen (P CSF O 2 ), CSF partial pressure of carbon dioxide (P CSF CO 2 ), and CSF pH with a blood gas analyzer. As the controls, the CSF was collected from 6 patients during surgery for an unruptured cerebral aneurysm. P CSF O 2 and P CSF CO 2 were expressed as the ratio to partial pressure of oxygen (P a O 2 ) and partial pressure of carbon dioxide (P a CO 2 ), respectively.
Results: P CSF O 2 /P a O 2 was 0.79 ± 0.14 in moyamoya disease, being lower than 1.10 ± 0.09 in the controls ( P < 0.0001). P CSF CO 2 /P a CO 2 was 0.90 ± 0.10 in moyamoya disease, being higher than 0.84 ± 0.07 in the controls ( P = 0.0261). P CSF O 2 /P a O 2 was significantly lower in pediatric patients than in adult patients and in the hemispheres with reduced cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide than in those with normal CBF but reduced CVR. STA-MCA anastomosis significantly increased P CSF O 2 /P a O 2 from 0.79 ± 0.14 to 0.86 ± 0.14 ( P < 0.01) and reduced P CSF CO 2 /P a CO 2 from 0.90 ± 0.10 to 0.69 ± 0.16 ( P < 0.0001). There was no difference in CSF pH between moyamoya disease and the controls.
Conclusion: P CSF O 2 /P a O 2 was significantly lower in moyamoya disease than in the controls. Its magnitude was more pronounced in pediatric patients than in adult patients and depends on the severity of cerebral ischemia. STA-MCA anastomosis carries dramatic effects on CSF gas tensions in moyamoya patients. CSF may be a valuable biomarker to monitor the pathophysiology of cerebral ischemia/hypoxia in moyamoya disease.
Competing Interests: There are no conflicts of interest.
(Copyright: © 2024 Surgical Neurology International.)
Databáze: MEDLINE
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