Artikel
Intraoperative quantification of cerebral perfusion by microscope-integrated analysis of near infrared indocyanine green fluorescence angiography
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Veröffentlicht: | 28. April 2011 |
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Gliederung
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Objective: Intraoperative measurements of cerebral blood flow are of interest during vascular neurosurgery. Near infrared indocyanine green (ICG) fluorescence angiography was introduced for visualizing vessel patency intraoperatively. However, quantitative information has not been available. Here, we report our experience with a microscope with integrated dynamic ICG fluorescence analysis system supplying semiquantitative information on blood flow.
Methods: ICG fluorescence curves of the cortex and the cerebral vessels were recorded by software integrated into the surgical microscope (“Flow 800” software; Zeiss Pentero) in 30 patients undergoing surgery for different pathologies. The following hemodynamic parameters were assessed: maximum fluorescence intensity, rise time, time to peak, cerebral blood flow index (cBFI) and transit times from arteries to cortex.
Results: For patients without obvious perfusion deficit, maximum fluorescence intensity was 177.7 arbitrary intensity units (AI; 5 mg ICG bolus), mean rise time 5.2 s (range: 2.9-8.2s; SD: 1.3s), mean time to peak 9.4 s (4.9-15.2 s, SD: 2.5s), mean cBFI 38.6 AI/s (13.5-180.6 AI/s; SD: 36.9s) and mean transit time 1.5 s (range: 360ms–3s, SD: 0.73s). For 3 patients with impaired cerebral perfusion, time to peak, rise time and transit time between arteries and cortex were markedly prolonged (>20s, >9s, >5s). In single patients the degree of perfusion impairment could be quantified by the cBFI ratios between normal and ischemic tissue. Transit times also reflected blood flow perturbations in arteriovenous fistulas.
Conclusions: Quantification of ICG-based fluorescence angiography appears to be useful for intraoperative monitoring of arterial patency and regional cerebral blood flow.