Evaluation of mitochondrial NADH and brain functions during retraction using a multiparametric monitoring system

The use of retractors is essential in many neurosurgical procedures however, substantial evidence indicates that the use of retractors induce contusion and infraction of the retracted tissue and adjacent regions. The main effect of retraction involved a clear decreased tissue blood flow and oxygenation and a decrease in energy production. In this study we tested the effects of retraction injury in a rat model related to several aspects. We tested the effect of duration and intensity of retraction as well as compared continuous versus intermittent retraction. In order to evaluate the hemodynamic and metabolic condition of the retracted tissue, a unique multiparametric monitoring probe (MPA) was used. This probe contained optical fibers for microcirculatory blood flow (CBF) monitoring by laser Doppler flowmetry and fibers for NADH fluorometry. Additionally, the MPA contains a Camino probe for intracranial pressure (ICP) monitoring, mini-electrode for K⁺ extracellular level monitoring surrounded by a DC-potential electrode and ECoG electrodes. Our preliminary results showed that retraction which induced an initial ICP pressure of 25mmHg, yielded only minor and reversible changes in cerebral metabolism whereas a pressure of 0mmHg caused a significant decrease in CBF, elevation of NADH and extracellular level of K⁺. In the intermittent retraction model the negative effect on the cerebral tissue was significantly larger than that of the single continuous retraction model. In conclusion, the use of the MPA for the evaluation of retraction induce injury, may reveal new insights into the damage developed in the brain.