Document Detail


An increase in extracellular glutamate is a sensitive method of detecting ischaemic neuronal damage during cranial base and cerebrovascular surgery. An in vivo microdialysis study.
MedLine Citation:
PMID:  9689326     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
All patients undergoing neurological surgery are at risk for serious complications. Ischaemic damage presenting with hemiparesis or speech difficulties occurs in up to 6% of patients undergoing cerebral bypass procedures and other complicated neurosurgical procedures. Currently available methods for detection of such damage include the use of somatosensory evoked potentials (SSEPs) and electro-encephalography (EEG). Unfortunately, these techniques have false positives and may remain normal in the presence of severe focal neurological deficits. Early detection of potential deficits may prevent or minimize damage through a change in operative or anaesthetic strategy. With the availability of several potential neuroprotective compounds, it is also possible to treat patients at risk of developing ischaemic complications if the individuals are identified early. The excitatory neurotransmitter glutamate is not only a metabolic product, but is also thought to promote ischaemia induced cell injury if released into the extracellular space. It may be a significant parameter for ischaemic brain metabolism. In this report we describe 10 patients who underwent extracranial-intracranial (EC-IC) high flow bypass procedures with routine intra-operative monitoring (IOM) as well as intra-operative in-vivo microdialysis measurement of glutamate. Our aim was to compare intra-operative microdialytic findings and IOM findings with respect to patients' early postoperative clinical courses. Three patients had significant intra-operative glutamate increases indicating ischaemia. Two of these patients awoke with a new neurological deficit (hemiparesis). Routine IOM findings were either normal or showed only transient changes during the time the glutamate levels were high. Our study shows that an increase in extracellular glutamate, as monitored by in-vivo microdialysis, is an excellent early market of neuronal damage. While our glutamate measurements were done off-line, it may be possible to get in future continuous on-line measurements to serve as an early warning system for potential ischaemic damage.
Authors:
A Mendelowitsch; L N Sekhar; D C Wright; A Nadel; H Miyashita; R Richardson; M Kent; A Shuaib
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta neurochirurgica     Volume:  140     ISSN:  0001-6268     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  1998  
Date Detail:
Created Date:  1998-10-28     Completed Date:  1998-10-28     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  AUSTRIA    
Other Details:
Languages:  eng     Pagination:  349-55; discussion 356     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, George Washington University Medical Center, Washington, DC, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Brain Damage, Chronic / diagnosis*
Brain Ischemia / diagnosis*
Cerebral Revascularization
Chondrosarcoma / surgery
Electroencephalography
Evoked Potentials, Somatosensory / physiology
Extracellular Space / chemistry*
Female
Glutamic Acid / analysis*
Humans
Intracranial Aneurysm / surgery*
Intraoperative Complications / diagnosis*
Male
Meningeal Neoplasms / surgery
Meningioma / surgery
Microdialysis*
Middle Aged
Neurofibroma / surgery
Neurologic Examination
Skull Base Neoplasms / surgery*
Chemical
Reg. No./Substance:
56-86-0/Glutamic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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