Effect of intraoperative jugular venous oximetry-based management on outcome in patients undergoing excision of intracranial meningiomas: A pilot study

Background and Aims: Continuous jugular venous oximetry using fiberoptic techniques can detect critical episodes of cerebral desaturation that may occur during excision of intracranial meningiomas where considerable blood loss and hemodynamic alterations occur. Thus, we planned this study to evaluate the neurological outcome of patients undergoing craniotomy for excision of meningiomas using intraoperative fiberoptic jugular venous oximetry versus the standard care. We hypothesized that intraoperative jugular venous oximetry monitoring in these patients will improve the patient outcome. Material and Methods: Patients (American Society of Anesthesiologists physical status I and II) aged 18 to 60 years undergoing elective craniotomy for excision of intracranial meningioma were randomized to receive either jugular venous oxygenation-based intraoperative management or standard anesthesia management. Patient demographics, intraoperative vitals, and length of hospital stay were noted. Patients’ neurological status was assessed telephonically at 1 month postoperatively using extended Glasgow outcome scale (GOSE). Results: A total of 40 patients were enrolled in this study. Demographics and intraoperative variables were comparable between two groups. There were five episodes of jugular venous oxygen desaturation in three (7.5%) of the study patients. None of the patients had jugular pressure more than 6 mm Hg at any time point of surgery, irrespective of position of the patient. The hemodynamic variables were comparable between the two groups. The mean lactate oxygen index was 0.002 in Group B. Both groups had no significant difference with respect to GOSE at 1 month. We did not observe any complications with respect to procedure and technique of placement of jugular venous catheter. Conclusions: Results of this preliminary study suggest that the intraoperative management guided by continuous jugular venous oximetry is not superior to standard management for improving neurological outcome in patients undergoing excision of intracranial meningiomas. Further research is necessary to confirm these findings and explore its complete potential.