• G Nath, G Korula, and M J Chandy.
• Christian Medical College Hospital, Vellore, India.
• J Neurosurg Anesthesiol. 1995 Jan 1; 7 (1): 1-6.

AbstractCerebrospinal fluid pressure (CSFP) was monitored through a lumbar intrathecal catheter in 32 patients undergoing transsphenoidal excision of pituitary macroadenomas. In the first 20 patients, standardized intermittent Valsalva maneuvers were followed by intrathecal saline injections in 2.5-ml increments. Their effects on CSFP, mean arterial pressure (MAP), and therefore, cerebral perfusion pressure (CPP) were compared. The increase in CSFP produced by one Valsalva maneuver (4 +/- 2 mm Hg) was similar to that produced by a single increment of intrathecal saline (4 +/- 2 mm Hg), but the effect of saline was more sustained. With Valsalva maneuvers, the maximum CSFP produced was 13 +/- 4 mm Hg, and the CPP decreased to 50 +/- 14 mm Hg, whereas with saline, the maximum CSFP was 25 +/- 7 mm Hg, and the CPP decreased to 59 +/- 13 mm Hg. Because the increase in CSFP was greater and better sustained with intrathecal saline, Valsalva maneuvers were omitted in the next 12 patients. Peroperative data, including surgical conditions, and post-operative morbidity, with special reference to low-pressure headache and meningeal infection, were analyzed in all 32 patients. Operative conditions produced with intrathecal saline were judged excellent or good in 75% of patients. However, because this technique can decrease the CPP excessively, we recommend that it be used only with continuous CSFP monitoring.

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