title: Intraoperative Indocyanine Green-Based Cortical Perfusion Assessment in Patients Suffering from Severe Traumatic Brain Injury.
abstract: OBJECTIVE
  The pathophysiology of traumatic brain injury (TBI) largely involves the brains vascular structural integrity. We analyzed the value of an intraoperative cortical indocyanine green (ICG) angiography in patients with severe TBI and acute subdural hematoma who underwent decompressive craniectomy.
  
  
  METHODS
  ICG-derived fluorescence curves of cortex and cerebral vessels were recorded by the use of software integrated into a surgical microscope in 10 patients. The maximum intensity, rise time (RT), time to peak, and residual fluorescence intensity (FI) were estimated from cortical arteries, the parenchyma, and veins.
  
  
  RESULTS
  ICG-derived fluorescence parameters were correlated with the short-term outcome 3 months after discharge. Five patients had a favorable and 5 an unfavorable outcome. Patients with a favorable outcome showed a significant longer RT in the arteries and a trend towards a significant longer RT in the veins. Overall mean residual FI was 47.5 ± 6.8% for the arteries, 45.0 ± 7% for the parenchyma and 57.6 ± 6% for the veins. The residual FI of the parenchyma and the veins was significantly greater in patients with an unfavorable clinical outcome.
  
  
  CONCLUSIONS
  Patients with an unfavorable clinical outcome showed an altered shape of the ICG-derived fluorescence curve, a shorter increase of the ICG-derived fluorescence intensity in the cortical arteries, and significantly greater residual fluorescence intensity. These observations are likely a correlate of an increased intracranial pressure, a capillary leak, and venous congestion. Intraoperative quantification of the ICG-derived fluorescence might help to appreciate the clinical outcome in patients with severe TBI.
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. Electronic address: MarcelAlexander.Kamp@med.uni-duesseldorf.de.
authors.forename: Marcel A
authors.initials: MA
authors.lastname: Kamp
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Sevgi
authors.initials: S
authors.lastname: Sarikaya-Seiwert
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Athanasios K
authors.initials: AK
authors.lastname: Petridis
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Beez
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Jan Frederick
authors.initials: JF
authors.lastname: Cornelius
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.affiliation: Institute for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Turowski
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Philipp J
authors.initials: PJ
authors.lastname: Slotty
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D056424:Decompressive Craniectomy / Q000379:methods; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D007208:Indocyanine Green
keywords: Cerebral blood flow; Cerebral perfusion; Decompressive craniectomy; ICG; Indocyanine green; Traumatic brain injury