The Influence of Controlled Hypotension on Cerebral Blood Flow During Neurosurgical Operations

Abstract

This article examines the effects of controlled hypotension on cerebral blood flow (CBF) during neurosurgical procedures. Controlled hypotension is a technique used to reduce intraoperative blood loss and improve surgical field visualization by lowering mean arterial pressure (MAP). While the method has long-standing applications in various surgeries, its impact on cerebral perfusion — especially in patients undergoing brain operations — remains complex and contested. This review integrates findings from clinical and experimental studies, demonstrating that although controlled hypotension can maintain cerebral perfusion pressure (CPP) within target ranges, it may not always improve CBF, particularly in patients with compromised autoregulatory mechanisms. Optimizing cerebral hemodynamics during neurosurgery requires careful balance to prevent hypoperfusion and secondary ischemic injury.