Background: 

Hyperosmolar therapy is the mainstay of treatment to reduce brain bulk and optimize surgical exposure during craniotomy. This study investigated the effect of equiosmolar doses of 7.5% hypertonic saline (HTS) and 20% mannitol on intraoperative cerebral oxygenation and metabolic status, systemic hemodynamics, brain relaxation, markers of cerebral injury, and perioperative craniotomy outcomes.

Methods: 

A total of 51 patients undergoing elective supratentorial craniotomy were randomly assigned to receive 7.5% HTS (2 mL/kg) or 20% mannitol (4.6 mL/kg) at scalp incision. Intraoperative arterial and jugular bulb blood samples were collected at predefined time intervals for assessment of various indices of cerebral oxygenation; multiple hemodynamic variables were concomitantly recorded. S100B protein and neuron-specific enolase levels were determined at baseline, and at 6 and 12 hours after surgery for assessment of neuronal injury. Brain relaxation and perioperative outcomes were also assessed.

Results: 

Demographic and intraoperative data, brain relaxation score, and perioperative outcomes were comparable between groups. Jugular bulb oxygen saturation and partial pressure of oxygen, arterial-jugular oxygen and carbon dioxide differences, and brain oxygen extraction ratio were favorably affected by 7.5% HTS up to 240 minutes postinfusion (P<0.05), whereas mannitol was associated with only a short-lived (up to 15 min) improvement of these indices (P<0.05). The changes in cerebral oxygenation corresponded to transient expansion of intravascular volume and improvements of cardiovascular performance. Increases in S100B and neuron-specific enolase levels at 6 and 12 hours after surgery (P<0.0001) were comparable between groups.

Conclusions: 

The conclusion is that 7.5% HTS has a more beneficial effect on cerebral oxygenation than an equiosmolar dose of 20% mannitol during supratentorial craniotomy, yet no clear-cut clinical superiority of either solution could be demonstrated.

中文翻译：

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7.5% 高渗盐水和 20% 甘露醇等摩尔剂量对幕上开颅手术期间脑氧合状态和脑损伤标志物释放的比较：一项随机对照试验

背景： 

高渗疗法是减少脑体积和优化开颅手术期间手术暴露的主要治疗方法。本研究调查了等摩尔剂量的 7.5% 高渗盐水 (HTS) 和 20%甘露醇对术中脑氧合和代谢状态、全身血流动力学、脑松弛、脑损伤标志物和围手术期开颅手术结果的影响。

方法： 

共有 51 名接受择期幕上开颅手术的患者被随机分配到头皮切口接受 7.5% HTS（2 mL/kg）或 20%甘露醇（4.6 mL/kg）。在预定的时间间隔收集术中动脉和颈静脉球血样本，用于评估脑氧合的各种指标；同时记录了多个血流动力学变量。S100B 蛋白和神经元特异性烯醇化酶水平在基线、手术后 6 小时和 12 小时测定，以评估神经元损伤。还评估了脑松弛和围手术期结果。

结果： 

两组间的人口统计学和术中数据、脑松弛评分和围手术期结果具有可比性。7.5% HTS 在输注后 240 分钟内对颈静脉球氧饱和度和氧分压、动脉-颈静脉氧和二氧化碳差异以及脑氧提取率有有利影响（P <0.05），而甘露醇仅与短暂-这些指数的改善（最多 15 分钟）( P <0.05)。脑氧合的变化对应于血管内容量的短暂扩张和心血管性能的改善。手术后 6 小时和 12 小时时 S100B 和神经元特异性烯醇化酶水平的增加 ( P <0.0001) 在组间具有可比性。

结论： 

结论是，在幕上开颅手术期间，7.5% HTS 比等摩尔剂量的 20%甘露醇对脑氧合有更有益的影响，但尚未证明这两种溶液具有明确的临床优势。