The relation between cerebral oxygenation and vasospasm in patients undergoing coil embolization

Aim: In this study, it was aimed to predict vasospasm that may develop in the postoperative period by measuring intraoperative cerebral oxygenation in patients with aneurysmatic subarachnoid hemorrhage who underwent coil embolization. Materials and Methods: This study was performed in a prospective randomized manner in 40 patients with aneurysmatic subarachnoid hemorrhage who underwent coil embolization, aged 18-70 years, included in the ASA I-IV classification. After the patients were taken to the operating room, standard monitoring (heart rate, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, end tidal carbon dioxide values, peripheral oxygen saturation), BIS (bispectral index) and cerebral oxygen saturation monitoring (Near infrared spectroscopy: NIRS) were applied. After anesthesia induction of the patients was performed with similar anesthetic agents, anesthesia maintenance was provided with sevoflurane and remifentanyl or with sevoflurane and propofol, depending on the clinician's preference. Values were recorded at baseline, after anesthesia induction, at the 5th, 10th, 15th, 30th, 60th, 90th minutes of the operation, at the end of surgery and at the end of anesthesia. A 25% decrease in NIRS value compared to baseline during the intraoperative follow-up was considered as vasospasm. Angiographically, segmental or diffuse narrowing of the lumen of the intracranial arteries was evaluated as vasospasm. Lasting at least 2 hours as a clinical follow-up parameter in the postoperative period; Confusion, disorientation, focal motor/sensory loss, speech disorder, pupillary reflex change were considered as vasospasm. Results: There was no significant difference between the patients in terms of demographic data. A statistically significant difference was found after induction in the intra-group comparisons of systolic, diastolic and mean arterial pressures according to the significant decrease in the NIRS score. A significant decrease was observed in the intraoperative NIRS score of 55.5% of the patients with postoperative vasospasm (p=0.007). In intra-group comparisons of systolic, diastolic and mean arterial pressures according to postoperative vasospasm status; the incidence of vasospasm in the postoperative period was statistically significantly higher in patients with lower baseline measurements (p<0.05). Conclusion: It is thought that intraoperative NIRS monitoring can predict postoperative vasospasm in patients with aneurysmatic subarachnoid hemorrhage who underwent coil embolization, and this may contribute positively to reducing morbidity.