Abstract
Background:Intraoperative qualitative indocyanine green (ICG) angiography has been used in cerebrovascular surgery. Hyperperfusion may lead to neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. The purpose of this study is to quantitatively evaluate intraoperative cerebral perfusion using microscope-integrated dynamic ICG fluorescence analysis, and to assess whether this value predicts hyperperfusion syndrome (HPS) after STA-MCA anastomosis.Methods:Ten patients undergoing STA-MCA anastomosis due to unilateral major cerebral artery occlusive disease were included. Ten patients with normal cerebral perfusion served as controls. The ICG transit curve from six regions of interest (ROIs) on the cortex, corresponding to ROIs on positron emission tomography (PET) study, was recorded. Maximum intensity (IMAX), cerebral blood flow index (CBFi), rise time (RT), and time to peak (TTP) were evaluated.Results:RT/TTP, but not IMAX or CBFi, could differentiate between control and study subjects. RT/TTP correlated (|r| = 0.534-0.807; P < 0.01) with mean transit time (MTT)/MTT ratio in the ipsilateral to contralateral hemisphere by PET study. Bland–Altman analysis showed a wide limit of agreement between RT and MTT and between TTP and MTT. The ratio of RT before and after bypass procedures was significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.60 ± 0.032 and 0.80 ± 0.056, respectively; P = 0.017). The ratio of TTP was also significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.64 ± 0.081 and 0.85 ± 0.095, respectively; P = 0.017).Conclusions:Time-dependent intraoperative parameters from the ICG transit curve provide quantitative information regarding cerebral circulation time with quality and utility comparable to information obtained by PET. These parameters may help predict the occurrence of postoperative HPS.
Highlights
The hemodynamic status of brain tissue can be classified into stage 0, stage 1, and stage 2.[7]
Ten patients undergoing superficial temporal artery to middle cerebral artery (STA‐MCA) bypass surgery for unilateral major cerebral artery occlusive disease who were referred to the Department of Surgical Neurology, Research Institute for Brain and Blood Vessels‐AKITA, Japan, between June 2011 and March 2013 were enrolled in this study [Table 1]
Postoperative magnetic resonance angiography (MRA) confirmed the patency of bypass graft in all cases, and magnetic resonance imaging (MRI) showed that symptomatic cerebral infarction did not occur after surgery in any patient
Summary
The hemodynamic status of brain tissue can be classified into stage 0 (normal flow state), stage 1 (cerebral autoregulatory vasodilatation to compensate for a decrease in blood flow toward the brain), and stage 2 (autoregulatory failure, with a compensatory rise in oxygen extraction fraction [OEF]).[7]. Recent studies have clarified that postoperative hyperperfusion may cause serious neurological complications, such as brain swelling, seizure, and intracerebral hemorrhage, after superficial temporal artery to middle cerebral artery (STA‐MCA) anastomosis in patients with severe hemodynamic compromise.[13,18,31] reliable intraoperative parameters to predict the occurrence of postoperative hyperperfusion have not been identified. Hyperperfusion may lead to neurological complications after superficial temporal artery to middle cerebral artery (STA‐MCA) anastomosis. The purpose of this study is to quantitatively evaluate intraoperative cerebral perfusion using microscope‐integrated dynamic ICG fluorescence analysis, and to assess whether this value predicts hyperperfusion syndrome (HPS) after STA‐MCA anastomosis
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