Characteristics of Intraoperative Abnormal Hemodynamics During Resection of an Intra-fourth Ventricular Tumor Located on the Dorsal Medulla Oblongata
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概要
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Abnormal hemodynamics during extirpation of a para-medulla oblongata (MO) tumor is common and may be associated with direct vagal stimulation of the medullary circuit. However, resection of tumors on the dorsal MO may also induce hemodynamic instability without direct vagal stimulus. The objective of this study was to examine the characteristics of hemodynamic instability unrelated to vagal stimulus during dissection of an intra-fourth ventricular tumor with attachment to the dorsal MO. A retrospective analysis was performed in 13 patients. Abnormal hemodynamics were defined as a > 20% change from the means of the intraoperative mean arterial pressure (MAP) and heart rate (HR). Relationships of intraoperative hemodynamics were evaluated with various parameters, including the volume of the MO. Six patients (46.2%) had intraoperative hypertension during separation of the tumor bulk from the dorsal MO. The maximum MAP and HR in these patients were significantly greater than those in patients with normal hemodynamics (116.0 ± 18.0 mmHg versus 85.6 ± 6.5 mmHg; 124.3 ± 22.8 bpm versus 90.5 ± 14.7 bpm). All six cases with abnormal hemodynamics showed hemodynamic fluctuation during separation of the tumor bulk from the dorsal MO. The preoperative volume of the MO in these patients was 1.11 cc less than that in patients with normal hemodynamics, but the volume after tumor resection was similar in the two groups (5.23 cc and 5.12 cc). This suggests that the MO was compressed by the conglutinate tumor bulk, with resultant fluctuation of hemodynamics. Recognition of and preparation for this phenomenon are important for surgery on a tumor located on the dorsal MO.
- 社団法人 日本脳神経外科学会の論文
著者
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Fujii Masami
Department Of Neurosurgery Clinical Neuroscience Yamaguchi University School Of Medicine
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Kajiwara Koji
Department Of Electrical Engineering And Information System School Of Engineering The University Of
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Yoshikawa Koichi
Department Of Neurosurgery Yamaguchi University School Of Medicine
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Ideguchi Makoto
Department Of Chemical Engineering Kyushu University
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Nomura Sadahiro
Department Of Neurosurgery Clinical Neuroscience Higher Biointegration Yamaguchi University Graduate School Of Medicine
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Suzuki Michiyasu
Department Of Neurosurgery Clinical Neuroscience Higher Biointegration Yamaguchi University Graduate School Of Medicine
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NOMURA Sadahiro
Department of Neurosurgery, Yamaguchi University Graduate School of Medicine
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SADAHIRO Hirokazu
Department of Neurosurgery, Yamaguchi University Graduate School of Medicine
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KAJIWARA Koji
Department of Neurosurgery, Yamaguchi University Graduate School of Medicine
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IDEGUCHI Makoto
Department of Neurosurgery, Yamaguchi University Graduate School of Medicine
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Suzuki Michiyasu
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Japan
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