Value of Cushing reflex as warning sign for brain ischaemia during neuroendoscopyâ€

In this study, we describe the haemodynamic effects of increased intracranial pressure during endoscopic neurosurgical procedures and their respective sequence of events at high temporal resolution. Although most clinicians rely on the occurrence of bradycardia to diagnose intracranial hypertension during endoscopic neurosurgical procedures, we show that a simultaneous onset of hypertension and tachycardia is a better indicator of impaired brain perfusion. Waiting for a persistent bradycardia to alert the surgeon during endoscopic neurosurgical procedures could allow severe bradycardia or even asystole to develop.