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

摘要 脑血管外科医生进行精密手术，如动脉瘤夹闭，动静脉畸形 切除术或血运重建手术可能受益，如果有关血流的定量信息 向他们提供了手术区域内血管的状况。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施用， 其中的一些对外科手术是破坏性的，因此是不希望的。像ICG视频这样的染料技术- 血管造影术可能不经常使用，并且通常仅用于手术成功的术后确认。 我们提出了一种新的方法，可以非侵入性地提供实时信息的血流在 神经外科医生的视野在微血管的空间尺度。这种模块化光学成像系统（称为 CVSurgeON ™）将与手术室中现有的神经外科显微镜集成， 神经外科医生-用户可以获得血流信息的按需视频馈送，以辅助手术决策。 该补充血流信息将使用专有和许可的激光散斑对比度获得 成像技术，并且可选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 感兴趣我们之前已经建立了一个原型的系统，并验证了其功能在小型和大型动物 可逆和不可逆的脑血管闭塞模型。我们建议的第二阶段项目旨在 调整我们的技术用于神经外科的临床应用，然后进行首次人体研究，以验证 在三种重要类型的脑血管手术中的系统性能和有用性-动脉瘤夹闭术， 动静脉畸形的烧灼和烟雾病的脑血管旁路手术。

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.