Dye-free, on-demand visualization of blood flow during cerebrovascular surgery

摘要 脑血管外科医生进行微妙的手术，如动脉瘤夹闭，动静脉畸形 如果与血流有关的定量信息，切除或血管重建术可能会受益 向他们提供手术范围内血管的状态。目前可以监测血液的技术 高分辨率的血流要么使用复杂的专用设备，要么依赖于造影剂的注射，两者都是 其中一些会破坏手术程序，因此是不受欢迎的。基于染料的技术，如ICG视频- 血管造影术可能不经常使用，通常只用于手术后确认手术成功。 我们提出了一种新的方法，可以非侵入性地提供血管内血流的实时信息 神经外科医生在微血管空间尺度上的视野。这种模块化光学成像系统(称为 CVSurgeONTM)将与手术室现有的神经外科显微镜集成在一起，提供 神经外科医生-用户按需提供血流信息，以帮助手术决策. 这种互补的血流信息将使用专利和授权的激光散斑对比来获得 成像技术，并选择性地在覆盖在该区域上的他/她的视野中呈现给神经外科医生 感兴趣的人。我们已经建立了该系统的原型，并在小动物和大动物身上验证了它的功能 脑血管可逆性和不可逆性闭塞模型。我们建议的第二阶段项目旨在 将我们的技术用于神经外科的临床应用，然后进行第一次人体研究，以验证 系统性能和在三种重要类型的脑血管手术中的应用--动脉瘤夹闭， 动静脉畸形的烧灼术和烟雾病的脑血管搭桥术。

ABSTRACT Cerebrovascular surgeons performing delicate surgeries such as aneurysm clipping, arteriovenous malformation resections, or revascularization procedures could benefit if quantitative information pertaining to the blood flow status of vessels in their surgical field was made available to them. Current technologies that can monitor blood flow at high resolution either use complex dedicated equipment or rely on administration of contrast agents, both of which are disruptive to the surgical procedure and hence, undesired. Dye-based techniques like ICG video- angiography may not be used frequently and often used only for post-surgical confirmation of surgical success. We propose a novel method that can noninvasively provide real-time information about blood flow in the neurosurgeon’s field of view at the spatial scale of microvessels. This modular optical imaging system (called the CVSurgeONTM) will integrate with existing neurosurgical microscopes in operating rooms providing the neurosurgeon-user an on-demand video feed of blood flow information to assist in surgical decision-making. This complementary blood flow information will be obtained using proprietary and licensed laser speckle contrast imaging technology, and optionally presented to the neurosurgeon in his/her visual field overlaid on the region of interest. We have previously built a prototype of the system and validated its function in small and large animal models of reversible and irreversible occlusion of vessels in the brain. Our proposed Phase II project aims to adapt our technology for clinical use in neurosurgery and then conduct first-in-human studies to validate the system performance and usefulness in three important types of cerebrovascular surgeries – aneurysm clipping, cauterization of arteriovenous malformations, and cerebrovascular bypass surgery for moyamoya disease.