Abstract
In aortitis syndrome, cerebral revascularization is considered for patients showing cerebral or retinal ischemic symptoms. In these patients, all branches from an aortic arch are usually occluded. Cerebral perfusion pressure is choronically so low that the range of cerebral autoregulation is shifted to the left or disappears. In such a condition, surgical revascularization may cause a breakthrough or hyperperfusion syndrome including an intracerebral hematoma. These complications make a poor prognosis.
The authors monitored the lumbar spinal pressure to detect the hyperperfusion or breakthrough during the operation for a patient with aortitis syndrome. Spinal pressure raised markedly just after an opening of the vein graft from the aorta to the common carotid artery, showing the breakthrough phenomenon. The graft was partially occluded, and the systemic blood pressure was lowered. Reopening of the graft only made a mild spinal pressure elevation. Systemic blood pressure was gradually returned to a habitual level postoperatively. Postoperative course was uneventful. Spinal pressure reflects the intracranial pressure well, which is raised by an increase of cerebral blood volume caused by the breakthrough phenomenon. This method is simple and does not need trepanation. It is an useful monitoring technique not only during the revascularization for aortitis patients, but also during carotid endarterectomy.
