gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Laser Speckle Contrast Analysis for intraoperative cortical perfusion assessment in patients undergoing direct surgical revascularization

Meeting Abstract

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  • N. Hecht - Department of Neurosurgery and Center for Stroke research Berlin (CSB)
  • J. Woitzik - Department of Neurosurgery and Center for Stroke research Berlin (CSB)
  • S. König - Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin
  • P. Horn - Department of Neurosurgery and Center for Stroke research Berlin (CSB)
  • P. Vajkoczy - Department of Neurosurgery and Center for Stroke research Berlin (CSB)

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.02.13

doi: 10.3205/12dgnc187, urn:nbn:de:0183-12dgnc1871

Published: June 4, 2012

© 2012 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: Laser Speckle Contrast Analysis (LASCA) is the gold standard for intraoperative assessment of relative cortical perfusion. The aim of the present study was to validate LASCA as a tool for real-time assessment of relative cortical perfusion in patients undergoing direct cerebral revascularization.

Methods: Intraoperative LASCA was evaluated while performing physiological tests in patients with characteristic pathophysiological properties. A total number of 43 patients were included in this study: 7 patients received intermediate- or high-flow bypass grafting for treatment of a giant aneurysm, 28 patients underwent standard STA-MCA bypass surgery due to chronic hemodynamic compromise and 8 patients served as hemodynamically healthy controls. The following parameters were tested: (1) the practicability of LASCA for obtaining reliable baseline perfusion measurements, (2) the sensitivity of LASCA for detection of slight changes in cortical perfusion and (3) the applicability of LASCA as a tool for continuous real-time assessment of dynamic perfusion changes.

Results: In all 43 patients, an immediate real-time visualization and measurement of relative cortical perfusion was obtained. Relative baseline perfusion measurements showed no difference between patients with hemodynamic compromise (1936 ± 487 Flux) and those without (1994 ± 493 Flux). After STA-MCA bypass grafting in patients with hemodynamic compromise, however, cortical baseline perfusion was significantly elevated compared to the preoperative measurement (2208 ± 631 Flux, p < 0.05). During a CO2 challenge in patients with verified hemodynamic compromise, LASCA showed a high sensitivity in detecting a slight perfusion increase of 9.6 ± 9%, compared to a perfusion increase of 31 ± 5% in hemodynamically healthy controls (p < 0.0001). In patients undergoing intermediate- or high-flow bypass grafting, LASCA permitted an immediate, online detection of the acute cortical perfusion drop following vessel test-occlusion and the subsequent perfusion increase after flow initiation through the bypass.

Conclusions: LASCA permits live, intraoperative assessment of relative cortical perfusion in real-time with high sensitivity and dynamic response properties. We suggest LASCA as the next feature that should be integrated into the surgical microscope for complementary assessment of cortical perfusion.