Intraoperative Laser Speckle Contrast Imaging For Real-Time Visualization of Cerebral Blood Flow in Cerebrovascular Surgery:\xa0Results From Pre-Clinical Studies

Antonella Mangraviti,Jaepyeong Cha,Abhishek Rege,Betty M Tyler,Francesco Volpin,M Jason Brooke,Samantha I Cunningham,Karan Raje,Judy Huang,Alessandro Olivi,Henry Brem

doi:10.1038/s41598-020-64492-5

Antonella Mangraviti, Jaepyeong Cha + Show 9 more

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https://doi.org/10.1038/s41598-020-64492-5

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Cerebrovascular surgery can benefit from an intraoperative system that conducts continuous monitoring of cerebral blood flow (CBF). Such a system must be handy, non-invasive, and directly integrated into the surgical workflow. None of the currently available techniques, considered alone, meets all these criteria. Here, we introduce the SurgeON™ system: a newly developed non-invasive modular tool which transmits high-resolution Laser Speckle Contrast Imaging (LSCI) directly onto the eyepiece of the surgical microscope. In preclinical rodent and rabbit models, we show that this system enabled the detection of acute perfusion changes as well as the recording of temporal response patterns and degrees of flow changes in various microvascular settings, such as middle cerebral artery occlusion, femoral artery clipping, and complete or incomplete cortical vessel cautery. During these procedures, a real-time visualization of vasculature and CBF was available in high spatial resolution through the eyepiece as a direct overlay on the live morphological view of the surgical field. Upon comparison with indocyanine green angiography videoangiography (ICG-VA) imaging, also operable via SurgeON, we found that direct-LSCI can produce greater information than ICG-VA and that continuous display of data is advantageous for performing immediate LSCI-guided adjustments in real time.

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Cerebrovascular surgery can benefit from an intraoperative system that conducts continuous monitoring of cerebral blood flow (CBF)
Upon comparison with indocyanine green angiography videoangiography (ICG-VA) imaging, operable via SurgeON, we found that direct-Laser Speckle Contrast Imaging (LSCI) can produce greater information than ICG-VA and that continuous display of data is advantageous for performing immediate LSCI-guided adjustments in real time
We demonstrate the preliminary proof of concept that, coupled with the neurosurgical benefits of this microscope integrated system, LSCI has the potential to become a routine tool for reliable and continuous intraoperative CBF monitoring during cerebrovascular surgery

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Cerebrovascular surgery can benefit from an intraoperative system that conducts continuous monitoring of cerebral blood flow (CBF). These techniques are invasive because they rely on the injection of contrast agents into the body, may carry risk of vascular injury and stroke, or require the assistance of a neuroradiologist and the use of iodinated contrast and ionizing radiation[4,12,13,14] These dye-based techniques can confirm success or failure of cerebrovascular surgery such as aneurysm obliteration and can allow for an assessment of anatomic results, of graft patency, or residual nidus in arteriovenous malformation (AVM)[7,15,16]; they are not able to provide real-time, continuous, and direct feedback on the CBF changes to the neurosurgeon during these procedures[17]. Its placement can be difficult especially in a deep surgical field and, most importantly, will require additional and sometimes multiple manipulations of the target vessels[22,24,25]

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