Artikel
Intraoperative observation of pial microcirculation during brain tumor surgery using orthogonal polarisation spectral imaging
Intraoperative Analyse der pialen Mikrozirkulation während der Operation von Hirntumoren mit dem Orthogonal Polarisation Spectral Imaging-Verfahren
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Aim of the current study was to test the feasibility of the orthogonal polarisation spectral imaging (OPSTM) for observation of pial microcirculation during neurosurgical procedures
Methods
9 patients (8 male, 1 female, mean age 48.7±13 years) with a malignant brain tumor (5 glioblastomas, 4 astrocytomas WHO III) were included in the study. Intraoperative intravital microscopy was performed using the CYTOSCANTM A/R (Cytometrics Inc., Philadelphia, PA, U.S.A.) equipped with a lens of 5x magnification and a CCD camera. The technique allows visualisation of haemoglobin-carrying structures. Online observations of the microvessels of the brain were performed immediately after opening the dura and after resection of the tumor at 5 sites of interest adjacent to the tumor edge. The images were stored on video tape for off-line analysis of vessel diameters, red blood cell velocity and functional capillary density.
Results
Initial functional capillary density was 80.3±7.8cm-1 (mean±SEM) and increased after resection of the tumor to 113.7±11.2 cm-1. The venuous diameters increased slightly from 39.7±3.0 to 55.0±15.4 μm. Arteriolar diameters remained unchanged. The number of venules with a red blood cell velocity under2mm/s increased from 34.4% to 54.0% indicating a better venous outflow after resection of the tumor.
Conclusions
CYTOSCANTM A/R is a suitable device for intraoperative observation of human brain microcirculation. Our data indicate that microcirculatory perfusion increases after removal of the tumor either because of the reduced local compression, the surgical manipulation or the loss of cerebrospinal fluid. Whether the technique would be useful for monitoring of microcirculatory parameters during other procedures such as temporary clipping in aneurysm surgery or resection of arteriovenous malformations remains to be elucidated.