J Korean Neurosurg Soc.  2003 Jul;34(1):27-32.

Control of Brain Retraction Pressure Using Epidural Intracranial Pressure Monitor System in Early Aneurysm Surgery

• Sung JH
• Lee SW
• Choi SJ
• Hong JT
• Woo HK
• Kim MC

Abstract

OBJECTIVE
To prevent retraction induced cerebral contusion during early aneurysm surgery, we propose a simple technical tip using commonly available Spiegelberg(R) epidural intracranial pressure(ICP) monitor system. METHODS: In this study, twenty six cases of early aneurysm clipping were enrolled. Routine pterional approach were performed. The air-pouch end of epidural ICP system was attached to the tip of Yasargil(R) retractor and the other end of connecter jack was plugged in digital converter. At each stage of approach, the value of retraction power was kept a record. Immediate feedback calls were announced in case of over 25mmHg of the values.
RESULTS
The average retraction pressure values at each stage were as follows. At the state of initial optic nerve confirmation, it was about 39+/-10.5mmHg. After immediate intentional re-adjust of the retraction power, it reduced to 22.8+/-4.5mmHg. After sufficient suck out of cerebrospinal fluid(CSF), it more reduced to 11.7+/-3.2mmHg. At the stage of juxta-aneurysmal brain retraction, it was about 9.0+/-4.1mmHg. By the aid of this system, no retraction induced contusion or hemorrhage were occurred.
CONCLUSION
This data indicate the usefulness of epidural ICP sensor attached brain retractor for real time feedback of retraction power. It may be another safeguard for successful early aneurysm surgery.

Keyword

Aneurysm; Epidural space intracranial pressure; Intraoperative monitor

MeSH Terms

Aneurysm*
Brain*
Contusions
Hemorrhage
Intracranial Pressure*
Optic Nerve