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Vol. 21. Issue 2.
Pages 99-107 (January 2010)
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Vol. 21. Issue 2.
Pages 99-107 (January 2010)
Complicaciones intraoperatorias del mapeo corticosubcortical
Intraoperative complications of corticosubcortical mapping
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P. Teixidor
Corresponding author
, R. García, M. Alamar, J. Muñoz, R. Florensa
Servicio de Neurocirugía. Hospital Germans Trias y Pujol. Badalona. Barcelona
M. González*, R. Llasera*
* Servicio de Anestesia. Hospital Germans Trias y Pujol. Badalona. Barcelona
M.J. Durá**
** Servicio de Rehabilitación. Hospital Germans Trias y Pujol. Badalona. Barcelona
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Resumen

Mediante una revisión de nuestra casuística y de la literatura analizamos las complicaciones intraoperatorias derivadas del uso de las estimulaciones cerebrales directas bajo anestesia general y anestesia local y sedación. Se realizó un estudio retrospectivo descriptivo de los pacientes intervenidos (2004–2008) en que se utilizó la técnica del mapeo corticosubcortical. Se determinaron como variables preoperatorias comunes: edad, sexo, localización tumoral, anatomía patológica, y en los pacientes operados despiertos, se registró el ASA, IMC y duración de la intervención. En los dos grupos se constataron la aparición de edema cerebral o crisis comiciales. En los pacientes despiertos se registró además las complicaciones respiratorias, hemodinámicas, toxicidad por anestésico local, nivel inadecuado de sedación, náuseas/vómitos, dolor e incomodidad postural. Bajo anestesia local y sedación se operaron 10, de 41 años de edad media, IMC medio de 26,8 y un ASA preoperatorio de I o II. La duración media de la intervención fue de 5 horas y 20 minutos. Mediante anestesia general se intervinieron 10 pacientes, de 55 años de media. En ningún caso de los dos grupos se constató edema cerebral, 4 pacientes presentaron crisis comiciales (autolimitadas con irrigación de suero frío). En 5 pacientes con anestesia local y sedación no registramos ninguna complicación, 2 pacientes episodios de desaturación sin complicaciones, 3 episodios de hipertensión y 2 incomodidad postural. Ninguna de las complicaciones intraoperatorias que registramos interfirió en el desarrollo de la cirugía. Es una técnica segura si se realiza siguiendo las indicaciones y los parámetros recomendados. Las crisis y complicaciones respiratorias son las complicaciones más frecuentes y a su vez las más temidas, puesto que pueden influir en casos problemáticos en el proceso de la cirugía.

Palabras clave:
Mapeo cerebral
Complicaciones
Abreviaturas:
ASA
ICM
Summary

By looking through our cases and literature, an analysis of the surgical complications derived from direct cerebral stimulation under general anesthesia and local anesthesia and sedation was made. A retrospective descriptive study was performed including patients who were intervened in our centre from 2004 to 2008 and had the cortico-subcortical mapping technique. Common pre-operation variables were as follow: Age, sex, tumor localization and tumor's pathology; On patients intervened while awake, we collected the ASA, BMI and duration of the intervention. Afterwards, variable like epileptic attacks and cerebral edema were included in two groups. In addition, on those awake, respiratory and circulatory complications, local anesthesia toxicity, poor level of sedation, nausea and vomiting, pain and feeling uncomfortable with body posture were collected as well. A total of 20 patients had surgery. 10 of them were operated under local anesthesia and sedation with a mean age of 41 years, mean BMI of 26.8 and a pre-operatory ASA score of I or II (except one patient with ASA III). The mean time duration of the surgical procedure was 5 hours and 20 minutes. On the other side, 10 patients were intervened with general anesthesia with a mean age of 55 years. There were no cases of cerebral edema in either group, although in 4 patients had epileptic attacks which resolved with cold saline irrigation. Five patients with local anesthesia and sedation did not have any complication, 2 patients showed desaturation episodes without further complications, three manifested hypertension episodes and two signs of feeling uncomfortable with body posture. None of the intra-operatory complications registered interfered wit the overall surgical procedure. This is a safe technique if performed following recommended indications and parameters. Regarding complications, respiratory complications are the most common and the most dangerous, as they can influence in the surgical procedure for difficult cases.

Key words:
Brain mapping
Intraoperative complications
Direct cerebral stimulation

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