INTRAOPERATIVE JUGULAR DESATURATION DURING SURGERY FOR TRAUMATIC INTRACRANIAL HEMATOMAS

Traumatic intracranial hematomas which are present on hospital admissi on or which develop during the hospital course are associated with a w orse neurological outcome than diffuse injuries. The purpose of this s tudy was to monitor jugular venous oxygen saturation (Sjvo(2)) during surgery for evacuation of traumatic intracranial mass lesions, to dete rmine the incidence and the causes of jugular venous desaturation, and to assess the usefulness of Sjvo(2) monitoring in this setting. Twent y-five severely head injured patients were monitored during 27 surgica l procedures. At the start of the surgical procedure, the median Sjvo( 2) was 47% (range 25%-89%). Seventeen (63%) of the patients had a Sjvo (2) less than 50%. Five patients had extremely low Sjvo(2) values (les s than or equal to 30%). Upon evacuation of the intracranial hematoma, there was a significant (P <0.001) increase in the median Sjvo(2) to 65% (range 50%-88%). Intracranial hypertension was the primary cause o f the low Sjvo(2), as confirmed by the response to surgical evacuation . Hypotension (mean arterial pressure <80 mm Hg) was a contributing fa ctor in seven of the cases of jugular desaturation. The definitive tre atment of a traumatic intracranial hematoma is surgical evacuation. Ho wever, during the period prior to evacuation of the hematoma, jugular venous desaturation was common, suggesting that monitoring Sjvo(2) mig ht provide useful information about the adequacy of cerebral perfusion .