Limitations of near infrared spectroscopy (NIRS) in neurosurgical setting: our case experience

  • Neeraja Ajayan
  • Keta Thakkar
  • Karen Ruby Lionel
  • Ajay Prasad HrishiEmail author
Letter to the Editor


One of the primary goals of anaesthesia in neurosurgical procedures is prevention of cerebral hypoxia leading to secondary neurological injury. Cerebral oximetry detects periods of cerebral hypoxemia and allows intervention for prevention of secondary brain injury and its sequelae. This can be achieved by the use of Near Infrared Spectroscopy (NIRS). In this regard, we present two cases where erroneous values of NIRS were shown which hindered monitoring of cerebral oxygenation in the intraoperative setting. In a neurosurgical setting, the erroneous values on the operative side could be attributed to altered tissue boundary conditions resulting in a changed optical path, which is normally held as a constant in NIRS measurements. The altered tissue boundary conditions could be due to the presence of air or blood between the myocutaneous flapskull, skull-dura, dura-brain interphases. It could also be that the sensors’ penetrating depth was inadequate to compensate for the increased distance between sensor and brain tissue, thereby resulting in inaccurately higher values (> 80%).


Near infrared spectroscopy Neurosurgery Cerebral oxygenation 



We would like to acknowledge Dr Gayatri Devi Nair MD, Transplant Fellow, Albert Einstein college of Medicine, New York, USA for editing the manuscript and for her valuable suggestions.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from the individual participants included in the study. None of individual participants identifying information is included in this article.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Neeraja Ajayan
    • 1
  • Keta Thakkar
    • 1
  • Karen Ruby Lionel
    • 2
  • Ajay Prasad Hrishi
    • 1
    Email author
  1. 1.Neuroanesthesia Division, Department of AnaesthesiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyTrivandrumIndia
  2. 2.Department of AnaesthesiologyChristian Medical CollegeVelloreIndia

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