Cerebrospinal Fluid Composition Modifications after Neuroendoscopic Procedures

Abstract

Normal saline solution is currently used as the ventricular irrigation fluid during neuroendoscopic procedures. The aim of this study is to determine the alterations in the cerebrospinal fluid (CSF) composition after neuroendoscopic interventions. Twenty nine patients who underwent a neuroendoscopic procedure under general anaesthesia were studied. Temperature inside the cerebral ventricle was measured and samples of CSF were taken to determinate oxygen and carbon dioxide partial pressures, pH, base excess, ionised calcium, standard bicarbonate, glucose, sodium, potassium, magnesium, total calcium, proteins, chlorine and osmolality before initiating the irrigation and after the neuronavigation. Patient demographics, neuronavigation time, total fluid volume used and temperature of the irrigation solution and complications that appeared in the first 24 hours were collected. Mean age of the patients was 42±18 years. The mean neuronavigation time was 21.5±15.4 minutes. The mean amount of saline solution used for irrigation was 919.6±994.7 mL. All the values studied in the CSF, except osmolality, showed significant variations. There was a significant correlation between the CSF variation of pH, oxygen and carbon dioxide partial pressures, base excess, standard bicarbonate, glucose and total calcium with respect to the total volume of irrigation solution, but not with respect to the neuronavigation time. A cut-off point of 500 mL of irrigation solution (sensitivity 0.7; specificity 0.87) was related with a CSF pH decrease greater than 0.2. The use of saline as irrigation solution during neuroendoscopic procedures produces important changes in CSF.

Key words

Anaesthesia - minimally invasive neurosurgery - neuroendoscopy - cerebrospinal fluid

References

• 1 Fábregas N, López A, Valero R, Carrero E, Caral L, Ferrer E. Anaesthetic management of surgical neuroendoscopies.  J Neurosurg Anesthesiol. 2000;  12 21-28
• 2 Beems T, Grotenhuis JA. Long-term complications and definition of failure of neuroendoscopic procedures.  Childs Nerv Syst. 2004;  20 868-877
• 3 Ambesh SP, Kumar R. Neuroendoscopic procedures: Anaesthetic considerations for a growing trend.  J Neurosurg Anesthesiol. 2000;  12 262-270
• 4 Longatti PL, Martinuzzi A, Fiorindi A, Maistrello L, Carteri A. Neuroendoscopic management of intraventricular hemorrhage.  Stroke. 2004;  35 e35-e38
• 5 Oka K, Yamamoto M, Masaaki MD, Nonaka T, Tomonaga M. The significance of artificial cerebrospinal fluid as perfusate and endoneurosurgery.  Neurosurgery. 1996;  38 733-736
• 6 Fábregas F, Valero R, Carrero E. et al . Episodic high irrigation pressure during surgical neuroendoscopy may cause intermittent intracraneal circulatory insufficiency.  J Neurosurg Anesthesiol. 2001;  13 152-157
• 7 Baykan N, Isbir O, Gerçek A, Dagçinar A, Z- ek MM. Ten years of experience with pediatric neuroendoscopic third ventriculostomy.  J Neurosurg Anesthesiol. 2005;  17 33-37
• 8 Van Aken J, Struys M, Verplancke T, de Baerdemaeker L, Caemaert J, Mortier E. Cardiovascular changes during endoscopic third ventriculostomy.  Minim Invas Neurosurg. 2003;  46 198-201
• 9 Elliot KAC, Jasper HH. Phisiological salt solutions for brain surgery: studies of local pH and pial vessels reactions to buffered and unbuffered isotonic solutions.  J Neurosurg. 1949;  6 140-152
• 10 El-Dawlatly AA. Blood biochemistry following endoscopic third ventriculostomy.  Minim Invas Neurosurg. 2004;  47 47-48
• 11 Anandh B, Madhusudan Reddy KR, Mohanty A, Umamaheswara Rao GS, Chandramouli BA. Intraoperative bradycardia and postoperative hyperkalemia in patients undergoing endoscopic third ventriculostomy.  Minim Invas Neurosurg. 2002;  45 154-157
• 12 Andrews RJ, Bringas JR, Alonzo G. Cerebrospinal fluid pH and pCO₂ rapidly follow arterial blood pH and pCO₂ with changes in ventilation.  Neurosurgery. 1994;  34 466-470
• 13 Burton MD, Johnson DC, Kazemi H. The central respiratory effects of acetylcholine vary with CSF pH.  J Auton Nerv Syst. 1997;  62 27-32
• 14 Burton MD, Johnson DC, Kazemi H. CSF acidosis augment ventilation through cholinergic mechanisms.  J Appl Physiol. 1989;  66 2565-2572
• 15 Davidson TL, Sullivan MP, Swanson KE, Adams JM. Cl-replacement alters the ventilatory response to central chemorreceptors stimulation.  J Appl Physiol. 1993;  74 280-285
• 16 Souto JM, Valero R, Fábregas N, Carrero E. Alcalosis respiratoria postoperatoria como complicación de la neuroendoscopia.  Rev Esp Anestesiol Reanim. 1997;  44 83-85
• 17 Velís L, Velís J, Moshé SL. Site-specific effects of local pH changes in the substancia nigra pars reticulata on flurothyl-induced seizures.  Brain Res. 1998;  782 310-313
• 18 Smith DA, Connick JH, Stone TW. Effect of changing extracellular levels of magnesium on spontaneous activity and glutamate release in the mouse neocortical slice.  Br J Pharmacol. 1989;  97 475-482
• 19 Kawano Y, Yoshida K, Hirata Y, Yoshimi H, Kuramochi M, Omae T. Influence of sodium concentration in cerebrospinal fluid on plasma atrial natriuretic peptide in conscious rats.  Clin Science. 1988;  74 49-52
• 20 Vaicys C, Fried A. Transient hyponatremia complicated by seizures after endoscopic third ventriculostomy.  Minim Invas Neurosurg. 2000;  43 190-191

Correspondence