Artikel
Intra-operative indocyaninegreen (ICG)-fluorescence derived quantification of cerebral perfusion during cerebral bypass surgery
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Veröffentlicht: | 4. Juni 2012 |
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Objective: The aim of our study was to evaluate intra-operative changes of cortical perfusion during cerebral revascularization surgery estimated by quantification of ICG-derived fluorescence.
Methods: ICG perfusion measurements where investigated in patients treated for cerebral stenoocclusive disease and Moya Moya syndrome during application of a standard superficial temporal artery to middle cerebral artery bypass (EC-/IC-) bypass. Cortical ICG fluorescence was quantified after application of a 5 mg bolus ICG in defined regions of interest (ROI) using the microscope integrated software "Flow800" (Zeiss Pentero; Carl Zeiss meditec, Oberkochen, Germany). Fluorescence intensity, rise time (RT, time between 10 and 90% of maximum fluorescence intensity), time to peak (TTP) and cerebral blood flow index (cBFI) were calculated before and after bypass surgery.
Results: In a series of 10 patients (each 5 for occlusive and Moya Moya desease) a total of 20 ICG measurements were performed. Mean age was 45 y (17–61 y). Before revascularization, overall maximum fluorescence intensity was 451.6 arbitrary intensity units, mean RT (4.1–12.1 s, SD: 2.5 s), mean TTP 10.9 s (8.4–20.4 s, SD: 4,4 s). Despite successful revascularization as evaluated by postoperative angiography, overall fluorescence parameters and CT-based perfusion parameters did not significantly change after surgery. We found no statistically significant correlation between perioperative course of ICG-derived fluorescence parameters and CT-based brain perfusion measurement.
Conclusions: Although quantification of ICG-derived fluorescence may be a promising approach for an intra-operative estimation of cerebral perfusion, we found no significant changes of ICG-derived fluorescence parameters before and after application of the bypass grafts and no correlation to CT-based perfusion measurements. Therefore, quantification of ICG-derived fluorescence seems to give no additional information during application of EC-/IC-bypass grafts.