New methods for monitoring cerebral oxygenation and hemodynamics in patients with subarachnoid hemorrhage.
Radiographic cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) do not reflect cerebral hemodynamics and oxygenation and may occur in the absence of clinical deficit and vice-versa. This report is to describe preliminary findings in further development of a non invasive method to estimate regional cerebral oxygenation and perfusion. Measurements were performed with a technique combining near infrared spectroscopy (NIRS) and indocyaningreen (ICG) dye dilution. Successful data analysis has been performed based on the decomposition in pulsatile and non-pulsatile components of NIRS absorption data collected before and during the passage of ICG through the vascular bed under the NIRS-detector. First measurements in patients with CVS suggest that the technique could become a powerful tool in the detection and treatment of CVS. This non invasive technique can be done at the bedside, it seems to be safe, easy to perform and less time-consuming compared to conventional techniques. The influence of extracerebral bone and surface tissue on cerebral NIRS signal has not been clarified yet. Therefore a new subdural NIRS probe has been developed, which gives the opportunity to measure directly the concentration of the chromophores in the brain without the influence of extracerebral contamination. In future comparative measurements with conventional NIRS probes on the scalp will allow to quantify and eliminate extracerebral contamination from the NIRS signal.
Keller
E
E
Department of Neurosurgery, University of Zurich, Zurich, Switzerland.
Nadler
A
A
Imhof
H G
HG
Niederer
P
P
Roth
P
P
Yonekawa
Y
Y
D000328:Adult; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000601:surgery; D001783:Blood Flow Velocity / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D001921:Brain / Q000098:blood supply; D004867:Equipment Design; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis* / Q000601:surgery; D007208:Indocyanine Green; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000601:surgery; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D010101:Oxygen Consumption / Q000502:physiology*; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D013355:Subdural Space; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000601:surgery
D007208:Indocyanine Green