Artikel
Laser Speckle Contrast Analysis for intraoperative cortical perfusion assessment in patients undergoing direct surgical revascularization
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Veröffentlicht: | 4. Juni 2012 |
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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.