Local Brain Pressure, Microcirculation and pH During Neurosurgical Operations
Already our daily neurosurgical experience demonstrates the adverse effects of locally increased brain pressure. If forced spatula retraction severely disturbs the microcirculation in the underlying brain tissue, a focal brain edema will rapidly follow, often associated with subarachnoid hemorrhage. The tissue damaged by the spatula pressure will undergo necrosis and large cystic defects are often the deplorable result of a careless neurosurgical technique with comfortable spatula retraction. High local brain pressures caused by spatula retraction have already been reported at the first international ICP symposium (Rivano et al. 1972) and special spatulas with automatic recording of retraction force have been designed by Albin and Bunegin (Codman Surgical Products Catalog 1985). Avoiding excessive spatula pressures is one of the main goals of microneurosurgery (Yasargil 1984) and various devices for self-retaining retractors have been developed in order to minimize the retraction force (Greenberg, “LEYLA”, Yasargil 1977). However, little is known about the quantitative effects of spatula pressures on local tissue blood flow and metabolism and exact thresholds of tissue tolerance have not been established.
KeywordsCortical Blood Flow Neurosurgical Operation Retraction Force Microsurgical Approach Stainless Steel Spatula
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