Cortical perfusion measurement by indocyanine-green videoangiography in patients undergoing hemicraniectomy for malignant stroke.
OBJECTIVE
Assessment of cerebral perfusion during neurosurgical procedures would be beneficial to identify areas at risk and to guide placement of monitoring probes. Therefore, we have adapted near-infrared indocyanine-green (ICG) videoangiography to assess cortical perfusion intraoperatively.


METHODS
ICG videoangiography was performed intraoperatively in 6 patients after decompressive hemicraniectomy for middle cerebral artery stroke. Flow maps of cortical perfusion were generated with IC-CALC 1.1 software by calculating the ratio of difference in fluorescence intensity and rise time.


RESULTS
Excellent visualization of cerebral arteries, cortical perfusion and collateral circulation via leptomeningeal anastomoses could be demonstrated in all cases. Flow maps revealed high spatial resolution and showed heterogeneous maple-leaf-shaped hypoperfusion. 26.5+/-13.7% and 29.0+/-9.1% of the exposed cortical surface (141+/-18 cm2) demonstrated core and penumbral flow, respectively.


CONCLUSIONS
ICG videoangiography appears to be a valuable tool to precisely detect relative cortical tissue perfusion. Thus, it may provide useful research data on the pathophysiology of human stroke, help surgeons to maintain adequate brain perfusion intraoperatively, and simplify adequate placement of tissue probes to monitor critically hypoperfused brain tissue.
Woitzik
Johannes
J
Department of Neurosurgery, University Hospital Mannheim, Faculty of Clinical Medicine, Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany. johannes.woitzik@nch.ma.uni-heidelberg.de
Peña-Tapia
Pablo G
PG
Schneider
Ulf C
UC
Vajkoczy
Peter
P
Thomé
Claudius
C
D000328:Adult; D002196:Capillaries / Q000000981:diagnostic imaging; D002533:Cerebral Angiography / Q000592:standards; D002540:Cerebral Cortex / Q000098:blood supply*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D004396:Coloring Agents; D003399:Craniotomy; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery; D012039:Regional Blood Flow; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D014743:Videotape Recording
D004396:Coloring Agents; D007208:Indocyanine Green