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Norepinephrine and cerebral blood flow regulation in patients with arteriovenous malformations

Stuer, Carsten
Ikeda, Toshiki
Stoffel, Michael
Luippold, Gerd
Sakowitz, Oliver
Meyer, Bernhard
Published in Neurosurgery. 2008, vol. 62, no. 6, p. 1254-1260; discussion 1260-1251
Abstract OBJECTIVE: To test the hypothesis that the sympathetic nervous system plays a role in cerebral blood flow regulation in patients with arteriovenous malformations (AVM). METHODS: Cortical interstitial norepinephrine was measured by means of microdialysis, regional cerebral blood flow was measured by a thermal diffusion technique, and regional oxygen saturation (SO2) was measured by microspectrophotometry in 12 patients harboring cerebral AVMs (AVM group) and in 15 patients with deep-seated nonvascular lesions (control group) before and after resection. Measurements were compared according to groups and times of measurements. All values are given as means +/- standard deviation. RESULTS: Cortical regional SO2 increased significantly (P < 0.05) in both groups after surgery (AVM group: presurgery 52.4 +/- 12.5% SO2, postsurgery 71.4 +/- 7.4% SO2; control group: presurgery 57.1 +/- 8.4% SO2, postsurgery 69.9 +/- 8.7% SO2), whereas regional cerebral blood flow increased only in the AVM group (AVM group: presurgery 18.9 +/- 6.6 ml/100 g/min, postsurgery 26.2 +/- 6.9 ml/100 g/min; control group: presurgery 20.1 +/- 7.6 ml/100 g/min, postsurgery 19.4 +/- 7.8 ml/100 g/min). Norepinephrine concentrations were significantly lower in the AVM group as compared with the control group before surgery. Although there was no significant difference between pre- and postsurgery conditions in the AVM group, the norepinephrine level of the control group was significantly lower after surgery (AVM group: presurgery 3.3 +/- 1.2 nmol/L, postsurgery 2.9 +/- 1.7 nmol/L; control group: presurgery 5.4 +/- 1.4 nmol/L, postsurgery 4.2 +/- 1.1 nmol/L). CONCLUSION: Chronically lowered perfusion pressure seems to induce the hypothesized adaptive down-regulation of sympathetic nervous system activity, yet protective up-regulation after a sudden elevation of cerebral perfusion pressure after AVM excision could not be shown in this study.
Keywords AdultCase-Control StudiesCerebral Cortex/*metabolism/physiopathologyCerebrovascular Circulation/*physiologyCohort StudiesFemaleHomeostasis/physiologyHumansIntracranial ArteriovenousMalformations/*metabolism/*physiopathology/surgeryIntracranial Pressure/physiologyMaleMiddle AgedNorepinephrine/*metabolismOxygen Consumption/physiology
PMID: 18824991
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Research group Groupe Schaller Karl-Lothard (neurochirurgie) (851)
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STUER, Carsten et al. Norepinephrine and cerebral blood flow regulation in patients with arteriovenous malformations. In: Neurosurgery, 2008, vol. 62, n° 6, p. 1254-1260; discussion 1260-1251. https://archive-ouverte.unige.ch/unige:19196

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Deposited on : 2012-03-27

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