A Novel Hyperspectral Imaging System for Intraoperative Prediction of Cerebral Hyperperfusion Syndrome after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in Patients with Moyamoya Disease
A Novel Hyperspectral Imaging System for Intraoperative Prediction of Cerebral Hyperperfusion Syndrome after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in Patients with Moyamoya Disease
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DOI：
10.1159/000513289
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发表时间：
2021-02-17
影响因子：
2.9
通讯作者：
Iihara, Koji
中科院分区：
文献类型：
--
作者：
Iwaki, Katsuma;Takagishi, Soh;Iihara, Koji
背景：烟雾病(MMD)患者经颞浅动脉(STA)-大脑中动脉(MCA)搭桥术后可能发生脑高灌注综合征(CHS)。预测术后CHS是具有挑战性的；然而，我们先前报道了在STA-MCA搭桥术中使用高光谱相机(HSC)监测术中脑表面血流动力学变化的可行性。目的：探讨HSC在预测MMD患者STA-MCA搭桥术后CHS中的应用价值。方法：采用HSC对29例MMD患者行STA-MCA搭桥术前后大脑皮质的高光谱图像进行分析。然后我们分析吻合后血氧饱和度的变化，并评估其与CHS的相关性。结果：5名患者在手术后几天出现一过性神经恶化。I-123-N-异丙基碘苯丙胺单光子发射计算机断层扫描结果显示吻合口局部脑血流量明显增加，无脑梗塞。吻合术后大脑皮层血氧饱和度明显升高(33+/-28比8+/-14%，p<；0.0001)。受试者操作特征分析结果显示，术后脑组织SO2值增加率为15%(敏感性85.0%，特异性81.3%，曲线下面积0.871)时，可能发生先天性心脏病。结论：大脑皮质高光谱成像可用于预测接受STA-MCA搭桥术的MMD患者术后的CHS。
Background: Postoperative cerebral hyperperfusion syndrome (CHS) may occur after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for moyamoya disease (MMD). Predicting postoperative CHS is challenging; however, we previously reported the feasibility of using a hyperspectral camera (HSC) for monitoring intraoperative changes in brain surface hemodynamics during STA-MCA bypass. Objective: To investigate the utility of HSC to predict postoperative CHS during STA-MCA bypass for patients with MMD. Methods: Hyperspectral images of the cerebral cortex of 29 patients with MMD who underwent STA-MCA bypass were acquired by using an HSC before and after anastomosis. We then analyzed the changes in oxygen saturation after anastomosis and assessed its correlation with CHS. Results: Five patients experienced transient neurological deterioration several days after surgery. I-123-N-Isopropyl-iodoamphetamine single-photon emission computed tomography scan results revealed an intense, focal increase in cerebral blood flow at the site of anastomosis without any cerebral infarction. Patients with CHS showed significantly increased oxygen saturation (SO2) in the cerebral cortex after anastomosis relative to those without CHS (33 +/- 28 vs. 8 +/- 14%, p < 0.0001). Receiver operating characteristic analysis results show that postoperative CHS likely occurs when the increase rate of cortical SO2 value is >15% (sensitivity, 85.0%; specificity, 81.3%; area under curve, 0.871). Conclusions: This study indicates that hyperspectral imaging of the cerebral cortex may be used to predict postoperative CHS in patients with MMD undergoing STA-MCA bypass.