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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Intraoperative thermographic imaging can help determine cortex perfusion status in patients with ischemic stroke

Meeting Abstract

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  • Yordan Radev - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Dresden
  • Nico Hoffmann - TU Dresden, Medizinische Fakultät Carl Gustav Carus, Dresden
  • Julia Hollmach - TU Dresden, Medizinische Fakultät Carl Gustav Carus, Dresden
  • Christian Schnabel - TU Dresden, Medizinische Fakultät Carl Gustav Carus, Dresden
  • Tobias Meyer - TU Dresden, Medizinische Fakultät Carl Gustav Carus, Dresden
  • Stephan Sobottka - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Dresden
  • Edmund Koch - TU Dresden, Medizinische Fakultät Carl Gustav Carus, Dresden
  • Gabriele Schackert - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Dresden
  • Gerald Steiner - TU Dresden, Medizinische Fakultät Carl Gustav Carus, Dresden
  • Matthias Kirsch - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Dresden

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.14.03

doi: 10.3205/14dgnc347, urn:nbn:de:0183-14dgnc3479

Published: May 13, 2014

© 2014 Radev 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: Determining the perfusion status of central nervous system tissue during neurosurgical procedures can be of diagnostic and therapeutic value. We hypothesized that during decompressive craniectomy performed for malignant stroke, ischemic regions as well as healthy tissue can be differentiated using infrared-based imaging of the cortical temperature.

Method: In 21 patients suffering from ischemic stroke, decompressive craniectomy was performed and a thermographic sequence of the exposed cortex was recorded using a highly sensitive infrared camera (thermal resolution <0.03°K). A bolus of cold saline (20 or 50 ml) was applied through a central line during imaging. Preprocessing and multivariate data analysis was performed on thermal image data using the MATLAB package. The thermogram was matched to a 3D model of the patient's brain using the Amira software package according to major anatomic landmarks.The thermal activity within and outside the infarct was compared.

Results: As a general rule, infarct borders corresponded to hypothermic cortex areas. 12 cases (57,14%) showed exact correlation, 7 cases (33,33%) correlated partially and 2 cases (9,53%) correlated poorly to infarct area. In cases with a short time frame between preoperative CT and craniectomy, correspondence was very exact. Tissue that appeared hypodense on CT was always hypothermic, and the arteries within these areas lacked the pulsatile temperature pattern displayed by those in healthy tissue. A temperature drop corresponding to the cold bolus was detected in major arteries in healthy tissue but never in arteries in ischemic tissue.

Conclusions: Thermography is a novel tool in assessing cortical perfusion status. Ischemic and perfused areas showed different thermal patterns, especially regarding cortical vessels. Thermography may be capable of detecting functioning pial anastomoses. It may also detect critically perfused tissue bordering the stroke area which can be used as a target for brain oxygen probes. It may be useful as a robust device to monitor temporary perfusion deficits as well.