<title>Fiber optic based multiprobe system for intraoperative monitoring of brain functions</title>

Abstract

Monitoring of brain functions during neurosurgical conditions have been made by various groups of investigators. Attempts were made to monitor EEG or evoked potentials, cerebral blood flow, mitochondrial redox state during various neurosurgical procedures. In order to monitor various functions of the brain we have developed a new multiprobe (MPA) assembly, based on fiber optic probes and ion selective electrodes, enabling the assessment of relative CBF, mitochondrial redox state (NADH fluorescence) and ion homeostasis in real-time, intraoperatively. The base features of the multiprobe assembly were described previously (A. Mayevsky, J. Appl. Physiol. 54, 740-748, 1983). The multiprobe holder (made of Delarin) contained a bundle of fibers transmitting light to and from the brain as well as 3 ion selective electrodes (K+%/, Ca(superscript 2+, Na+) combined with DC steady potential electrodes (Ag/AgCl). The common part of the light guide contained 2 groups of fibers. For the Laser Doppler flowmetry one input fiber and two output fibers were glued in a triangular shape and connected to the standard commercial plug of the Laser Doppler flowmeter. For the monitoring of NADH redox state 10 excitation and 10 emission fibers were randomly mixed between and around the fibers used for the Laser Doppler flowmetry. This configuration of the fibers enabled us to monitor CBF and NADH redox state from about the same tissue volume. The ion selective electrodes were connected to an Ag/AgCl electrode holders and the entire MPA was protected by a Plexiglass sleeve. Animal experiments were used for the verification of the methods and recording of typical responses to various pathological situations. The entire multiprobe assembly was sterilized by the standard gas sterilization routine and was checked for electrodes integrity and calibration inside the operation room 24 hours later. The MPA was located on the exposed human cortex using a micromanipulator and data collection started immediately after, using a micro computer based data acquisition system. After recording of baseline levels of CBF, NADH redox state and extracellular ion levels, the responses to CBF decrease (occlusions of a blood vessel) were recorded followed by the recovery period. A significant correlation between the CBF and NADH redox state changes was recorded. This approach enabled us to correlate this change in energy supply, to those of extracellular ion concentration. The preliminary results obtained suggest that the usage of the MPA in the operating room may have a significant contribution to the neurosurgeon as a routine diagnostic tool. It seems to us that a simplified MPA which will enable to monitor only the relative CBF, NADH redox state as well as extracellular K+ is more appropriate for future usage.