Detection of cerebral ischemia in neurovascular surgery using quantitative frequency-domain near-infrared spectroscopy
Detection of cerebral ischemia in neurovascular surgery using quantitative frequency-domain near-infrared spectroscopy
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DOI：
10.3171/jns.2007.106.2.283
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发表时间：
2007-02-01
影响因子：
4.1
通讯作者：
Charbel, Fady T.
中科院分区：
文献类型：
--
作者：
Calderon-Arnulphi, Mateo;Alaraj, Ali;Charbel, Fady T.
Object.在神经血管手术过程中监测缺血体征具有重要价值。目前的术中监测技术提供的实时反馈具有有限的准确性。定量频域近红外光谱（Q-NIRS）可测量组织氧合血红蛋白（HbO（2））、脱氧血红蛋白（HHb）和总血红蛋白（tHb）浓度以及脑组织氧饱和度（SO），这在监测术中缺血证据时可能是有用的。使用Q-NIRS，作者监测了25例神经血管手术，包括动脉瘤夹置入、动静脉畸形切除术、颈动脉内膜切除术、颞浅动脉-大脑中动脉（MCA）搭桥手术、颈外动脉-MCA搭桥手术、脑硬脊膜肌血管粘连和球囊闭塞试验。Q-NIRS技术可提供独立于头皮组织的可测量脑氧合值。因此，Q-NIRS测量的变量的变化定量地反映了脑组织灌注。所有病例均进行双侧监测，其中5例患者在手术过程中出现临床缺血事件。1例患者术中失血伴全身性低血压并发生弥漫性脑水肿，1例患者术中发生缺血事件并在术后发生枕叶卒中，1例患者术中颈动脉夹闭期间脑电图显示减慢; 2例患者球囊闭塞试验失败。在手术过程中发生缺血事件的所有病例中，Q-NIRS监测显示HbO（2）、tHb和SQ（2）降低，而Hb升高。定量频域近红外光谱以无创的方式提供关于脑氧合和血液动力学的可量化和连续的实时信息。这种连续的术中氧合监测是一种很有前途的方法，用于检测神经血管手术期间的缺血事件。
Object. There is great value in monitoring for signs of ischemia during neurovascular procedures. Current intraoperative monitoring techniques provide real-time feedback with limited accuracy. Quantitative frequency-domain near-infrared spectroscopy (Q-NIRS) allows measurement of tissue oxyhemoglobin (HbO(2)), deoxyhemoglobin (HHb), and total hemoglobin (tHb) concentrations and brain tissue oxygen saturation (SO,), which could be useful when monitoring for evidence of intraoperative ischemia.Methods. Using Q-NIRS, the authors monitored 25 neurovascular procedures including aneurysm clip placement, arteriovenous malformation resection, carotid endarterectomy, superficial temporal artery-middle cerebral artery (MCA) bypass surgery, external carotid artery-MCA bypass surgery, encephaloduromyosynangiosis, and balloon occlusion testing. The Q-NIRS technology provides measurable cerebral oxygenation values independent from those of the scalp tissue. Thus, alterations in the variables measured with Q-NIRS quantitatively reflect cerebral tissue perfusion. Bilateral monitoring was performed in all cases.Five of the patients exhibited evidence of clinical ischemic events during the procedures. One patient suffered blood loss with systemic hypotension and developed diffuse brain edema intraoperatively, one patient suffered an ischemic event intraoperatively and developed an occipital stroke postoperatively, and one patient showed slowing on electroencephalography intraoperatively during carotid clamping; in two patients balloon occlusion testing failed. In all cases of ischemic events occurring during the procedure, Q-NIRS monitoring showed a decrease in HbO(2), tHb, and SQ(2), and an increase in HHb.Conclusions. Quantitative frequency-domain near-infrared spectroscopy provides quantifiable and continuous realtime information about brain oxygenation and hemodynamics in a noninvasive manner. This continuous intraoperative oxygenation monitoring is a promising method for detecting ischemic events during neurovascular procedures.