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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Laser speckle contrast analysis (LASCA) – a non-invasive tool for intraoperative assessment of cortical tissue perfusion, CO2 reactivity and cerebral autoregulation

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  • Nils Hecht - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Deutschland; Centrum für Schlaganfallforschung Berlin (CSB), Berlin, Deutschland
  • Johannes Woitzik - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Deutschland; Centrum für Schlaganfallforschung Berlin (CSB), Berlin, Deutschland
  • Peter Horn - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Deutschland
  • Peter Vajkoczy - Neurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Deutschland; Centrum für Schlaganfallforschung Berlin (CSB), Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1592

doi: 10.3205/10dgnc067, urn:nbn:de:0183-10dgnc0679

Published: September 16, 2010

© 2010 Hecht et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Recently, Laser Speckle Contrast Analysis (LASCA) has been introduced as a novel imaging tool for non-invasive intraoperative assessment of cortical cerebral blood flow (CBF). The aim of the present study was to assess, whether next to perfusion, LASCA is also suitable for intraoperative determination of CO2 reactivity and cerebral autoregulation.

Methods: 31 Patients undergoing standard extracranial-intracranial (EC-IC) bypass surgery (20 patients), decompressive hemicraniectomy (5 patients) or non-related craniotomy (6 patients) were included. The portable LASCA device was centered over the surgical field and continuous recordings of cortical CBF-flux were obtained. For intraoperative assessment of the CO2 reactivity in patients with hemodynamic compromise, LASCA was performed with simultaneous CO2 challenge. In a subgroup of patients with Moyamoya disease (MMD), CO2 challenge was omitted and baseline perfusion was measured before and after completion of the anastomosis. The cerebral autoregulation was tested in patients with malignant hemispheric stroke through artificial alterations in mean arterial pressure (MAP). Validity of the results was determined by comparison to LASCA in patients undergoing craniotomy for either brain tumor surgery (3 patients) or grid-electrode placement due to medication refractory epilepsia (3 patients).

Results: In all cases, we achieved immediate visualization and measurement of relative CBF in addition to flow imaging the cortical vasculature. CO2 challenge in patients undergoing bypass procedures resulted in a parallel increase in cortical CBF-flux both before (12±10%) and after (12±12%) completion of the anastomosis. However, the rise in CBF-flux during CO2 increase was significantly lower in hemodynamically compromised patients than in control patients without cerebrovascular disease (20±5%; p<0.05, one-way ANOVA). Baseline CBF measurements in patients with MMD were significantly higher after completion of the bypass anastomosis. Assessment of cerebral autoregulation after malignant hemispheric stroke showed evidence of a disturbed autoregulation with positive correlation of MAP and CBF-flux recordings. In healthy control patients LASCA demonstrated an intact autoregulation with stable CBF-flux recordings during MAP alterations.

Conclusions: LASCA enables reliable, low-cost and non-invasive intraoperative assessment of CO2 reactivity and cerebral autoregulation.