• Jithumol Thankam Thomas, Hrishi PAjay PrasadAP0000-0001-9419-0543Neuroanesthesia and Critical care, Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. drajay@sctimst.ac.in., Ranganatha Praveen, Manikandan Sethuraman, Unnikrishnan Prathapadas, Smita Vimala, and Oommen Mathew.
• Neuroanesthesia and Critical care, Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. drjithu88@gmail.com.
• J Clin Monit Comput. 2024 Jun 1; 38 (3): 623630623-630.

PurposeCerebral arteriovenous malformations (AVM) represent focal abnormal areas of low resistance circulation which render the peri-nidal neuronal tissue susceptible to ischemia. The post-excision cerebral perfusion surge can result in hyperaemic complications.We hypothesised that Near Infrared Spectroscopy (NIRS)-guided perioperative management can aid in the prediction and prevention of perioperative complications in patients presenting for surgical excision of cerebral AVMs. We also intended to identify a threshold value of regional cerebral oxygen saturation (rScO2) to predict the incidence of perioperative complications.MethodsThis was a prospective observational study involving patients undergoing elective supratentorial AVM resection surgeries. Intraoperative rScO2 and hemodynamic monitoring were done and continued for postoperatively for 12 h. Any drift in rScO2 by > 12% from baseline was managed as per study protocol and perioperative adverse events were recorded and analyzed. Post surgery,for analytical purpose patients were categorized into two groups, Group A - patients without complications and Group B - patients who had complications postoperatively.ResultsTwenty-five patients presenting for surgical excision of cerebral AVM were recruited for this study of which 9 patients had postoperative adverse events and were allocated to group B. The ipsilateral mean rScO2 at the time of complication (Pc) was significantly lower in Group B than in group A [62.08 ± 9.33 vs.70.52 ± 7.17; p = 0.04]. The mean ipsilateral rScO2 drift from N2- N5 (i.e., post excision) was significantly higher in Group B than in Group A [12.01 ± 2.63% vs. 4.98 ± 5.7%;p = 0.02]. Mean ipsilateral rScO2 Drift ratio (N5 :N2) was significantly higher in group B as compared to group A [1.32 ± 0.01 vs. 1.01 ± 0.06;p < 0.001]. In the immediate post excision phase, the ipsilateral mean rScO2 was significantly higher in Group B at the post excision time point compared to Group A [ 83.03 ± 6.08 vs. 73.52 ± 7.07;p < 0.01)]. The mean ipsilateral rScO2 drift from N1-N6 (i.e., postoperatively) was significantly higher in Group B as compared to Group A [14.96 ± 0.080% vs. 6.88 ± 4.5% ; p < 0.01]. Similarly, the Mean Ipsilateral rScO2 Drift ratio (N6:N1) was significantly lower in group B as compared to group A [2.17 ± 0.02 vs. 1.05 ± 0.03 ;p < 0.0001].ConclusionsIn patients undergoing cerebral AVM resection, a post-resection ipsilateral rScO2 increase by > 12% with a drift ratio of > 1.3 could signify cerebral hyperemia. A postoperative ipsilateral rScO2 drift > 14.5% with a drift ratio of 2.1 from the baseline is associated with postoperative complications in our study. Further multi-centric randomized control trials are needed to support our research findings.© 2023. The Author(s), under exclusive licence to Springer Nature B.V.

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