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de Font-Réaulx E, López RL, Díaz López LG. Infrared thermography mapping plus neuronavigation target location in an eloquent area cavernoma resection. Surg Neurol Int 2020; 11:44. [PMID: 32257570 PMCID: PMC7110428 DOI: 10.25259/sni_435_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background Safety and efficacy are irrebuttable goals in neurosurgery. Methods We performed a subcortical cavernoma resection in an eloquent area, where we recorded and compared the maximal and minimal brain temperature measured by an infrared thermographic camera and thermometer with the neuronavigation (NN) target location and real anatomical lesion location. Results The hottest cortical point correlated to the subcortical cavernoma location. The NN located the target at 10 mm away from the hottest point. Conclusion More studies are needed to better understand the thermic radiation of the brain in health and in disease, but we believe that evaluating brain temperature, it could be possible to improve accuracy in neurosurgery and generate more knowledge about brain metabolism in vivo.
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Affiliation(s)
| | - Ramón López López
- Department of Neurosurgery, High Specialty Medical Unit, La Raza Hospital, Mexican Social Security Institute, Mexico City, México
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Janca R, Jezdik P, Jahodova A, Kudr M, Benova B, Celakovsky P, Zamecnik J, Komarek V, Liby P, Tichy M, Krsek P. Intraoperative Thermography of the Electrical Stimulation Mapping: A Safety Control Study. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2126-2133. [PMID: 30475703 DOI: 10.1109/tnsre.2018.2871875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A standard procedure for continuous intraoperative monitoring of the integrity of the corticospinal tracts by eliciting muscle responses is the electric stimulation mapping (ESM). However, standard ESM protocols are ineffective in 20% of young children. We have developed a novel, highly efficient paradigm consisting of short-time burst (30 ms) of high frequency (500 Hz) and high peak current (≤100 mA), which may cause local tissue overheating. The presented safety control study was therefore designed. The infrared thermography camera captured to-be-resected cortex of 13 patients in vivo during ESM. Thermograms were image processed to reveal discrete ESM thermal effect of currents from 10 to 100 mA. Peak 100 mA currents induced a maximal increase in temperature of 3.1 °C, 1.23±0.72 °C in average. The warming correlated with stimulating electrode resistance ( ). The measurement uncertainty was estimated ± 1.01 ºC for the most skeptical conditions. The histopathological evaluation of stimulated tissue (performed in all cases) did not show any destructive changes. Our study demonstrates the ability of the thermographic camera to measure the discrete thermal effect of the ESM. The results provide evidence for the safety of the proposed protocol for full range currents with minimal risk of brain tissue damage.
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de Font-Réaulx Rojas E, Martínez Ochoa EE, López López R, López Díaz LG. Infrared thermography brain mapping surveillance in vascular neurosurgery for anterior communicating artery aneurysm clipping. Surg Neurol Int 2018; 9:188. [PMID: 30294492 PMCID: PMC6169343 DOI: 10.4103/sni.sni_58_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background: Infrared thermography (IT) is a noninvasive, real-time diagnostic method that requires no contact with the patient and has a broad spectrum of potential applications in neurosurgery. It has been previously demonstrated the high sensitivity and specificity that IT has to detect brain blood flow changes. Case Description: The case is based on a 64-year-old diabetic and hypertensive male, to whom an anterior communicating artery (ACoA) incidental aneurysm was discovered. We performed the basal infrared thermography mapping (ITM) and immediately after the transitory clip placement in both A1 segments of the anterior cerebral artery (A1-ACA), we performed a second ITM of the exposed brain cortex. After the definitive clip placement in the neck of the ACoA aneurysm, we removed the transitory clips of both A1-ACA and performed a third ITM of the cortical surface, without finding any cortical cooling or significative temperature differences (Ϫt) compared to the basal ITM. The postoperatory computed tomography (CT) and angio-CT did not show any ischemic damage and confirmed the accurate aneurysm clipping. Conclusions: The ITM seems to be a real-time, safe, and useful brain mapping method to identify different temperature zones and temperature dispersion gradients in the human brain cortex. More studies are needed to evaluate the potential applications of IT mapping of the human brain and its use in neurosurgery and vascular neurosurgery.
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Affiliation(s)
| | - Edith Elizabeth Martínez Ochoa
- Department of Neuroanesthesiology, National Institute for Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, México
| | - Ramón López López
- Department of Neurosurgery, High Speciality Medical Unit, La Raza Hospital, Mexican Social Security Institute, Mexico City, México
| | - Luis Guillermo López Díaz
- Department of Neuroanesthesiology, National Institute for Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, México
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Müller J, Schreiter V, Böhl E, Steiner G, Koch E, Schackert G, Kirsch M. Application of thermography for cerebral perfusion imaging during aneurysm surgery. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2018. [DOI: 10.1515/cdbme-2018-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe success of aneurysm surgery depends on complete clipping of the aneurysmal sacculation without compromising quality of cerebral perfusion of vessels concerned. An established intraoperative method to visualize cerebral blood flow i n a pparent v essels i s fl uorescence vi deo angiography based on indocyanine green (ICG). However, major disadvantages of indocyanine green video angiography (ICG VA) are the need of a specialized imaging system, potential drug side effects as well as the limited number of repetitions due to long decay time of ICG in blood circulation. In particular the last drawback prevents brain parenchymal perfusion monitoring with ICG VA. The application of time-resolved thermography as a fast, contactless, noninvasive, marker-free and harmless imaging tool became a promising approach for perfusion imaging and thus offers several advantages compared to ICG. Measurements of deep structures in heat traps for identification of i nternal patterns, e ssential f or e .g. s uccess monitoring of aneurysm clipping, are still unsolved challenges of thermography. This work reveals as a proof of concept that the combination of thermography and an intravenous cold saline bolus injection as a contrast agent is capable to detect arterial and parenchymal perfusion located in the surgical cavity during aneurysm surgery in comparison to state-of-the-art ICG VA. The investigations provide evidence that thermography has the capability to perform intraoperative imaging of cerebral perfusion at an advanced stage in surgery for vessels and parenchyma located both cortically and in the surgical cavity.
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Affiliation(s)
- Juliane Müller
- 1TU Dresden, Faculty of Medicine Carl Gustav Carus, Anesthesiology and Intensive Care Medicine, Clinical Sensoring and Monitoring, Fetscherstraße 74, 01307Dresden, Germany
| | - Valentin Schreiter
- 2TU Dresden, Faculty of Medicine Carl Gustav Carus, Neurosurgery,Dresden, Germany
| | - Elisa Böhl
- 2TU Dresden, Faculty of Medicine Carl Gustav Carus, Neurosurgery,Dresden, Germany
| | - Gerald Steiner
- 3TU Dresden, Faculty of Medicine Carl Gustav Carus, Anesthesiology and Intensive Care Medicine, Clinical Sensoring and Monitoring,Dresden, Germany
| | - Edmund Koch
- 3TU Dresden, Faculty of Medicine Carl Gustav Carus, Anesthesiology and Intensive Care Medicine, Clinical Sensoring and Monitoring,Dresden, Germany
| | - Gabriele Schackert
- 2TU Dresden, Faculty of Medicine Carl Gustav Carus, Neurosurgery,Dresden, Germany
| | - Matthias Kirsch
- 2TU Dresden, Faculty of Medicine Carl Gustav Carus, Neurosurgery,Dresden, Germany
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Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia. PLoS One 2015; 10:e0137430. [PMID: 26368024 PMCID: PMC4569513 DOI: 10.1371/journal.pone.0137430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/17/2015] [Indexed: 01/19/2023] Open
Abstract
Acute limb ischemia is a common cause of morbidity and mortality following trauma both in civilian centers and in combat related injuries. Rapid determination of tissue viability and surgical restoration of blood flow are desirable, but not always possible. We sought to characterize the response to increasing periods of hind limb ischemia in a porcine model such that we could define a period of critical ischemia (the point after which irreversible neuromuscular injury occurs), evaluate non-invasive methods for characterizing that ischemia, and establish a model by which we could predict whether or not the animal’s locomotion would return to baselines levels post-operatively. Ischemia was induced by either application of a pneumatic tourniquet or vessel occlusion (performed by clamping the proximal iliac artery and vein at the level of the inguinal ligament). The limb was monitored for the duration of the procedure with both 3-charge coupled device (3CCD) and infrared (IR) imaging for tissue oxygenation and perfusion, respectively. The experimental arms of this model are effective at inducing histologically evident muscle injury with some evidence of expected secondary organ damage, particularly in animals with longer ischemia times. Noninvasive imaging data shows excellent correlation with post-operative functional outcomes, validating its use as a non-invasive means of viability assessment, and directly monitors post-occlusive reactive hyperemia. A classification model, based on partial-least squares discriminant analysis (PLSDA) of imaging variables only, successfully classified animals as “returned to normal locomotion” or “did not return to normal locomotion” with 87.5% sensitivity and 66.7% specificity after cross-validation. PLSDA models generated from non-imaging data were not as accurate (AUC of 0.53) compared the PLSDA model generated from only imaging data (AUC of 0.76). With some modification, this limb ischemia model could also serve as a means on which to test therapies designed to prolong the time before critical ischemia.
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Abstract
Oxygen is the proverbial 'double-edged sword' in that it is a necessity for life in moderation and toxic and detrimental to life in excess. This too is the dilemma in hyperbaric oxygen (HBO) treatment in cerebral ischemic-anoxic insults such as stroke, head injury, near drowning, asphyxia, cardiac arrest, etc., i.e. the brain at risk, where regions of ischemia are beside regions of marked hyperemia. The natural heterogeneity of normal brain tissue oxygenation compounds the problem with different microvascular brain regions living at various levels of oxygenation from 0 to arterial PO(2) as an added complication. The application of HBO, whether normobaric or hyperbaric, will result in brain tissue oxygenation ranging from normoxic to highly hyperoxic with the latter possibly exacerbating the injury sustained. On this basis, the application of multiple therapeutic interventions may be considered, for example, HBO in combination with free radical scavengers or inhibitors of free radical generating enzymes. Despite these difficulties in moderating oxygen delivery to treat cerebral ischemic-anoxic insults, overwhelming preclinical evidence indicates that HBO administered during or within 2 hours post-insult effectively attenuates the severity of brain damage sustained. The primary disconnection between pre-clinical and clinical efficacy of HBO then appears to be the time of application. Clinically, HBO therapy is applied at the earliest 6 hours post-insult but usually between 12 hours or longer post-insult. Pre-hospital application of HBO may be required for clear-cut demonstration of clinical efficacy.
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Affiliation(s)
- Edwin M Nemoto
- Department of Radiology, B-804 Presbyterian University Hospital, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Aneurysmal subarachnoid hemorrhage models: do they need a fix? Stroke Res Treat 2013; 2013:615154. [PMID: 23878760 PMCID: PMC3710594 DOI: 10.1155/2013/615154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/31/2013] [Accepted: 06/04/2013] [Indexed: 11/17/2022] Open
Abstract
The discovery of tissue plasminogen activator to treat acute stroke is a success story of research on preventing brain injury following transient cerebral ischemia (TGI). That this discovery depended upon development of embolic animal model reiterates that proper stroke modeling is the key to develop new treatments. In contrast to TGI, despite extensive research, prevention or treatment of brain injury following aneurysmal subarachnoid hemorrhage (aSAH) has not been achieved. A lack of adequate aSAH disease model may have contributed to this failure. TGI is an important component of aSAH and shares mechanism of injury with it. We hypothesized that modifying aSAH model using experience acquired from TGI modeling may facilitate development of treatment for aSAH and its complications. This review focuses on similarities and dissimilarities between TGI and aSAH, discusses the existing TGI and aSAH animal models, and presents a modified aSAH model which effectively mimics the disease and has a potential of becoming a better resource for studying the brain injury mechanisms and developing a treatment.
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Zhou ZL, Jiang YB, Li GB, Gao YH. [Analysis of facial far-infrared thermogram of patients with acute facial neuritis]. ZHONG XI YI JIE HE XUE BAO = JOURNAL OF CHINESE INTEGRATIVE MEDICINE 2011; 9:1221-1225. [PMID: 22088588 DOI: 10.3736/jcim20111110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE In order to provide an objective observational index for facial neuritis, the authors monitored the changes of facial far-infrared thermogram in patients with acute facial neuritis. METHODS A total of 23 patients with acute facial neuritis were enrolled from Department of Acupuncture and Moxibustion, Chinese PLA General Hospital. Another 21 healthy participants were selected as the control group. Focal plane thermal imaging system (thermal sensitivity 0.05 degrees centigrade) was applied to collect facial far-infrared thermogram. Temperature differences in the thermogram of both sides of the cheeks, inner canthus, supraorbitals and forehead of the same patient were compared separately and statistically and analyzed by software provided by the imaging system. RESULTS Results of far-infrared thermography of the patients displayed obvious temperature differences ranging from 0.01 to 0.26 degrees centigrade between two sides of the cheeks, inner canthus, supraorbitals and forehead areas. In the control group, far-infrared thermogram showed that there were no obvious temperature differences between two sides of the cheeks, inner canthus, supraorbitals and forehead. There were significant differences in temperature difference in the four monitoring areas between the two groups (P<0.01). Among the 23 patients, there were 14 patients with congestive change, 7 with ischemic change and 2 with both congestive and ischemic changes. CONCLUSION The facial far-infrared thermogram of patients with acute facial neuritis is characterized mainly by congestive changes. Far-infrared thermography can objectively reflect the changes of blood-supply status in patients with facial neuritis.
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Affiliation(s)
- Zhang-ling Zhou
- Department of Acupuncture and Moxibustion, Chinese PLA General Hospital, Beijing 100853, China.
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Shussman N, Abu Gazala M, Schlager A, Elazary R, Khalaileh A, Zamir G, Kushnir D, Rivkind AI, Mintz Y. Laparoscopic Infrared Imaging—The Future Vascular Map. J Laparoendosc Adv Surg Tech A 2011; 21:797-801. [DOI: 10.1089/lap.2010.0474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Noam Shussman
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mahmoud Abu Gazala
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Avraham Schlager
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Department of Surgery, New York University, New York, New York
| | - Ram Elazary
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Abed Khalaileh
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gideon Zamir
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Kushnir
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Avraham I. Rivkind
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Mintz
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Matias JEF, Morais FA, Kato DMP, Koziak V, Brioschi ML, Tambara EM, Agulham MÂ, Coelho JCU. [Prevention of normothermic hepatic ischemia during in situ liver perfusion with three different preservation solutions: experimental analysis by realtime infrared radiation thermography]. Rev Col Bras Cir 2011; 37:211-7. [PMID: 21079894 DOI: 10.1590/s0100-69912010000300009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 06/13/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To establish the usefulness of infrared radiation thermography on monitoring in situ liver perfusion with different preservation solutions during liver harvesting. METHODS Twenty-four adult male Wistar rats, weighing 385.31 g were randomly divided into four groups of six animals each according to the solution used to perfuse the liver (Euro-Collins® solution--EC group; Custodiol® solution--CUST group; Celsior® solution--CEL group and Ringer-Lactate solution--RL group). Under inhalatory ether anesthesia, animals were submitted to upper transversal laparotomy, exposure of median and left-lateral hepatic lobes, heparin injection (500 UI/Kg) through infrahepatic vena cava, portal vein infusion through 18G catheter of cold (4°C) solution according to the group of study. Infrared images, with respective temperature evaluations from hepatic surface, were picked up in real time by Therma CAM SC500® infrared camera positioned at constant distance from three fixed points of the diaphragmatic surface of median and left lateral lobes at the following moments regarding liver perfusion: immediately after laparotomy; after portal vein cannulation and immediately before solution infusion; at each minute from the beginning of liver perfusion during five minutes. Mean temperatures of each moment were compared intra and intergroups with the difference between means test with normal distribution, with significance level of 5% (p=0.05). RESULTS There was statistically significant difference of means temperatures between the moment of laparotomy and immediately after cannulation; between this later and after the first minute of perfusion; and between the first and fifth minutes of infusion in all groups of study in a similar way. CEL group showed additional difference between the first and second minutes means temperatures. Intergroup comparison showed Euro-Collins solution with significant less cooling power when compared to all others solutions. CONCLUSION It was possible to follow the liver cooling process during preservation solutions perfusion using infrared radiation images. Preservation solutions had similar behaviors, with Celsior® solution showing additional cooling power until the second minute of perfusion. Euro-Collins solution had less cooling power than other solutions studied.
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Steiner G, Sobottka SB, Koch E, Schackert G, Kirsch M. Intraoperative imaging of cortical cerebral perfusion by time-resolved thermography and multivariate data analysis. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:016001. [PMID: 21280907 DOI: 10.1117/1.3528011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A new approach to cortical perfusion imaging is demonstrated using high-sensitivity thermography in conjunction with multivariate statistical data analysis. Local temperature changes caused by a cold bolus are imaged and transferred to a false color image. A cold bolus of 10 ml saline at ice temperature is injected systemically via a central venous access. During the injection, a sequence of 735 thermographic images are recorded within 2 min. The recorded data cube is subjected to a principal component analysis (PCA) to select slight changes of the cortical temperature caused by the cold bolus. PCA reveals that 11 s after injection the temperature of blood vessels is shortly decreased followed by an increase to the temperature before the cold bolus is injected. We demonstrate the potential of intraoperative thermography in combination with multivariate data analysis to image cortical cerebral perfusion without any markers. We provide the first in vivo application of multivariate thermographic imaging.
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Affiliation(s)
- Gerald Steiner
- Dresden University of Technology, Medical Faculty Carl Gustav Carus, Clinical Sensoring and Monitoring, University Hospital, Department of Neurosurgery, 01307 Dresden, Germany.
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Nakagawa A, Fujimura M, Arafune T, Sakuma I, Tominaga T. Clinical implications of intraoperative infrared brain surface monitoring during superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease. J Neurosurg 2010; 111:1158-64. [PMID: 19425891 DOI: 10.3171/2009.4.jns08585] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). Symptomatic cerebral hyperperfusion is a potential complication of this procedure, but its treatment is contradictory to that for ischemia. Because intraoperative techniques to detect hyperperfusion are still lacking, the authors performed intraoperative infrared monitoring in moyamoya disease using a novel infrared imaging system. METHODS During superficial temporal artery-middle cerebral artery anastomosis in 25 patients (26 hemispheres) with moyamoya disease, the authors monitored the brain surface temperature intraoperatively with the IRIS-V infrared imaging system. The average gradation value change (indicating temperature change) was calculated using commercial software. Magnetic resonance imaging, MR angiography, and N-isopropyl-p-[(123)I]iodoamphetamine SPECT studies were performed routinely before and within 10 days after surgery. RESULTS Patency of bypass, detailed local hemodynamics, and changes in cortical surface temperature around the anastomosis site were well recognized by the IRIS-V infrared imaging system in all cases. In the present study, 10 patients suffered transient neurological symptoms accompanied by an increase in CBF around the anastomosis site, recognized as symptomatic hyperperfusion. The increase in temperature was significantly higher in these patients. Intensive blood pressure control was undertaken, and free-radical scavengers were administered. No patient in the present study suffered a permanent neurological deficit. CONCLUSIONS Although the present method does not directly monitor surface CBF, temperature rise around the anastomosis site during surgery might be an indicator of postoperative hyperperfusion. Prospective evaluation with a larger number of patients is necessary to validate this technique.
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Affiliation(s)
- Atsuhiro Nakagawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi; and
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Ribeiro HDW, Silva GAPD, Brioschi ML, Nascimento AJD, Biondo-Simões MDLP, Matias JEF. Termografia infravermelha em tempo real como método de avaliação da viabilidade do baço em modelo de esplenectomia parcial em porcos. Rev Col Bras Cir 2009; 36:438-41. [DOI: 10.1590/s0100-69912009000500013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 02/17/2009] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Determinar se a termografia infravermelha é capaz de detectar com precisão a perda de perfusão tecidual em áreas de parênquima esplênico. MÉTODOS: Cinco porcos Landrace pesando entre 12 a 15 kg, após medicação pré-anestésica intramuscular e anestesia por infusão endovenosa, foram submetidos a quatro etapas de ligaduras sequenciais, dos vasos arteriais para o pólo inferior do baço: 1-vasos do ligamento esplênico; 2-ramo da artéria esplênica para o pólo inferior; 3-ramo arterial para o pólo inferior na face visceral do órgão; 4-parênquima esplênico dividindo o órgão. As imagens foram captadas por câmera Therma CAM SC500 instalada a 50 centímetros da superfície do órgão. As temperaturas foram medidas na região proximal (vascularizada) e na região distal (isquêmica), em três áreas circulares distintas de cada região através do software SAT Report, antes e após cada etapa de ligaduras, constituindo cinco grupos de medidas: tempo 0 = antes da etapa 1; tempo 1 = após etapa 1; tempo 2 = após etapa 2; tempo 3 = após etapa 3; tempo 4 = após etapa 4. RESULTADOS: Houve manutenção da temperatura da região proximal (vascularização preservada) durante todos os tempos de desvascularização. A temperatura da região distal (desvascularizada) iniciou queda a partir da primeira ligadura e tornou-se estatisticamente menor que a da região proximal a partir da ligadura 3 (Etapa 3). Houve diferença estatisticamente significativa entre as temperaturas proximais e distais do órgão na medida em que foram sendo realizadas as ligaduras vasculares. CONCLUSÃO: A termografia infravermelha foi capaz de distinguir com precisão áreas de parênquima esplênico com vascularização preservada de áreas isquêmicas e pode contribuir para a avaliação da viabilidade de órgãos sólidos.
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Intraoperative infrared brain surface blood flow monitoring during superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease: clinical implication of the gradation value in postoperative clinical course--a case report. ACTA NEUROCHIRURGICA. SUPPLEMENT 2009. [PMID: 19388309 DOI: 10.1007/978-3-211-85578-2_32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
BACKGROUND Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is a safe and effective treatment for moyamoya disease. Symptomatic cerebral hyperperfusion is a potential complication of this procedure, especially in adult cases. Accurate diagnosis of postoperative hyperperfusion is important because its treatment is contradictory to that for ischemia. Intraoperative techniques to detect hyperperfusion are still lacking. METHODS We performed intraoperative infrared (IR) brain surface monitoring in a 36-year-old man who underwent left STA-MCA anastomosis. FINDINGS IR monitoring not only detected the patency of bypass, as also confirmed by conventional Doppler sonography and postoperative magnetic resonance angiography, but also delineated the local brain surface hemodynamics after revascularization. Analysis of gradation value disclosed an abnormal increase in brain surface cerebral blood flow (indirectly indicated as a temperature change) after removal of the temporary clip. The patient suffered from transient right upper extremity numbness and dysarthria due to focal hyperperfusion from postoperative days 2 through 6. Intensive blood pressure control completely relieved his symptoms, and he was discharged without neurologic deficit. CONCLUSIONS Intraoperative brain surface monitoring by IR imaging may be useful to predict cerebral hyperperfusion after revascularization surgery for moyamoya disease. Further evaluation with a larger number of patients is necessary to validate this technique.
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Memarian N, Venetsanopoulos AN, Chau T. Infrared thermography as an access pathway for individuals with severe motor impairments. J Neuroeng Rehabil 2009; 6:11. [PMID: 19371440 PMCID: PMC2676297 DOI: 10.1186/1743-0003-6-11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 04/16/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with severe motor impairments often require an alternative access pathway, such as a binary switch, to communicate and to interact with their environment. A wide range of access pathways have been developed from simple mechanical switches to sophisticated physiological ones. In this manuscript we report the inaugural investigation of infrared thermography as a non-invasive and non-contact access pathway by which individuals with disabilities can interact and perhaps eventually communicate. METHODS Our method exploits the local temperature changes associated with mouth opening/closing to enable a highly sensitive and specific binary switch. Ten participants (two with severe disabilities) provided examples of mouth opening and closing. Thermographic videos of each participant were recorded with an infrared thermal camera and processed using a computerized algorithm. The algorithm detected a mouth open-close pattern using a combination of adaptive thermal intensity filtering, motion tracking and morphological analysis. RESULTS High detection sensitivity and low error rate were achieved for the majority of the participants (mean sensitivity of all participants: 88.5% +/- 11.3; mean specificity of all participants: 99.4% +/- 0.7). The algorithm performance was robust against participant motion and changes in the background scene. CONCLUSION Our findings suggest that further research on the infrared thermographic access pathway is warranted. Flexible camera location, convenience of use and robustness to ambient lighting levels, changes in background scene and extraneous body movements make this a potential new access modality that can be used night or day in unconstrained environments.
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Affiliation(s)
- Negar Memarian
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
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Kateb B, Yamamoto V, Yu C, Grundfest W, Gruen JP. Infrared thermal imaging: a review of the literature and case report. Neuroimage 2009; 47 Suppl 2:T154-62. [PMID: 19332140 DOI: 10.1016/j.neuroimage.2009.03.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 03/14/2009] [Accepted: 03/18/2009] [Indexed: 10/21/2022] Open
Abstract
Intraoperative Thermal Imaging (ITI) is a novel neuroimaging technique that can potentially locate the margins of primary and metastatic brain tumors. As a result, the additional real-time anatomical and pathophysiological information may significantly contribute to an improved extent of tumor resection. Our objectives in this article are i) to briefly discuss the current status of intraoperative imaging modalities including ITI and ii) to present a case report that evaluates the usefulness of ITI in detection of brain tumor and its margins. In this case report, ITI was used in a patient with a metastatic intracortical melanoma. The thermal profile of the tumor and surrounding normal cerebral cortex were mapped with a ThermaCAM P60 (TCP60) infrared camera by FLIR Systems. The data obtained by TCP60, intra-operatively, revealed a clear demarcation of tumor with significant temperature differences, up to 3.3 degrees C, between the tumor core (36.4 degrees C) and the surrounding normal tissue (33.1 degrees C). Ultrasound and pre-resection MR and CT confirmed the position and size of the metastasis. The volume of the tumor was preoperatively calculated using the CyberKnife software and postoperative volumetric measurement of the tumor residual was calculated by the Gamma Knife software. Our result, along with previously published results of others, suggests that thermal imaging could be used to provide a rapid, non-invasive, and real-time intra-operative imaging.
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Affiliation(s)
- Babak Kateb
- Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
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Capraro GA, Coughlin BF, Mader TJ, Smithline HA. Testicular Cooling Associated With Testicular Torsion and its Detection by Infrared Thermography: An Experimental Study in Sheep. J Urol 2008; 180:2688-93. [DOI: 10.1016/j.juro.2008.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Geoffrey A. Capraro
- Tufts University School of Medicine, Boston and Department of Emergency Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Bret F. Coughlin
- Department of Radiology, Hartford Hospital, Hartford, Connecticut
| | - Timothy J. Mader
- Tufts University School of Medicine, Boston and Department of Emergency Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Howard A. Smithline
- Tufts University School of Medicine, Boston and Department of Emergency Medicine, Baystate Medical Center, Springfield, Massachusetts
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Nakagawa A, Fujimura M, Arafune T, Sakuma I, Tominaga T. Intraoperative infrared brain surface blood flow monitoring during superficial temporal artery-middle cerebral artery anastomosis in patients with childhood moyamoya disease. Childs Nerv Syst 2008; 24:1299-305. [PMID: 18622619 DOI: 10.1007/s00381-008-0682-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To monitor patency of the bypass and to accomplish comprehensive visualized evaluation of brain surface hemodynamics in childhood moyamoya patients, we performed intraoperative monitoring using novel infrared imaging system. MATERIALS AND METHODS Intraoperative monitoring of brain surface blood flow by IRIS V infrared imaging system has been conducted during superficial temporal artery-middle cerebral artery anastomosis on seven sides of five pediatric patients with moyamoya disease (man/woman = 2:3, 7-8 years old). The range of recipient artery was 0.7-0.8 mm (average 0.75 mm). Magnetic resonance imaging and magnetic resonance angiography were performed routinely before and after surgery. CONCLUSIONS In all cases, patency of bypass, as well as detailed local hemodynamics and changes of brain surface temperature distribution could be evaluated. Intraoperative infrared system will be a feasible monitoring not only for noninvasive intraoperative evaluation of bypass patency but also for local hemodynamics even in patients with childhood moyamoya disease.
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Affiliation(s)
- Atsuhiro Nakagawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
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Gorbach AM, Wang H, Dhanani NN, Gage FA, Pinto PA, Smith PD, Kirk AD, Elster EA. Assessment of Critical Renal Ischemia With Real-Time Infrared Imaging. J Surg Res 2008; 149:310-8. [DOI: 10.1016/j.jss.2008.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 02/05/2008] [Accepted: 02/07/2008] [Indexed: 11/26/2022]
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Linder-Ganz E, Gefen A. The effects of pressure and shear on capillary closure in the microstructure of skeletal muscles. Ann Biomed Eng 2007; 35:2095-107. [PMID: 17899378 DOI: 10.1007/s10439-007-9384-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
Abstract
Deep tissue injury (DTI) is a severe pressure ulcer, which initiates in muscle tissue under a bony prominence, and progresses outwards. It is associated with mechanical pressure and shear that may cause capillaries to collapse and thus, induce ischemic conditions. Recently, some investigators stipulated that ischemia alone cannot explain the etiology of DTI, and other mechanisms, particularly excessive cellular deformations may be involved. The goal of this study was to evaluate the functioning of capillaries in loaded muscle tissue, using animal and finite element (FE) models. Pressures of 12, 37, and 78 kPa were applied directly to one gracilis muscle of 11 rats for 2 h. Temperatures of the loaded and contralateral muscles were recorded with time using infrared thermography (IRT) as a measure of the ischemic level. In addition, a non-linear large deformation muscle-fascicle-level FE model was developed and subjected to pressures of 12-120 kPa without and with simultaneous shear strain of up to 8%. For each simulation case, the accumulative percentage of open capillary cross-sectional area and the number of completely closed capillaries were determined. After 2 h, temperature of the loaded muscles was 2.4 +/- 0.3 degrees C (mean +/- standard deviation) lower than that of the unloaded contralateral limbs (mean of plateau temperature values across all pressure groups). Temperature of the loaded muscles dropped within 10 min but then remained stable and significantly higher than room temperature for at least 30 additional minutes in all pressure groups, indicating that limbs were not completely ischemic within the first 40 min of the trials. Our FE model showed that in response to pressures of 12-120 kPa and no shear, the accumulative percentage of open capillary cross-sectional area decreased by up to 71%. When shear strains were added, the open capillary cross-sectional area decreased more rapidly, but even for maximal loading, only 46% of the capillaries were completely closed. Taken together, the animal and FE model results suggest that acute ischemia does not develop in skeletal muscles under physiological load levels within a timeframe of 40 min. Since there is evidence that DTI develops within a shorter time, ischemia is unlikely to be the only factor causing DTI.
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Affiliation(s)
- Eran Linder-Ganz
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, 69978, Israel
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Sukstanskii AL, Yablonskiy DA. Theoretical model of temperature regulation in the brain during changes in functional activity. Proc Natl Acad Sci U S A 2006; 103:12144-9. [PMID: 16880401 PMCID: PMC1567709 DOI: 10.1073/pnas.0604376103] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Indexed: 11/18/2022] Open
Abstract
The balance between metabolic heat production, heat removal by blood flow, and heat conductance defines local temperature distribution in a living tissue. Disproportional local increases in blood flow as compared with oxygen consumption during functional brain activity disturb this balance, leading to temperature changes. In this article we have developed a theoretical framework that allows analysis of temperature changes during arbitrary functional brain activity. We established theoretical boundaries on temperature changes and explained how these boundaries depend on physiology (blood flow and metabolism) and external (heat exchange with the environment) experimental conditions. We show that, in regions located deep in the brain, task performance should be accompanied by temperature decreases in regions where blood flow increases (activated regions) and by temperature increases in regions where blood flow decreases (deactivated regions). The sign of temperature effect may be reversed for superficial cortex regions, where the baseline brain temperature is lower than the temperature of incoming arterial blood due to the heat exchange with the environment. Importantly, due to heat conductance, the temperature effect is not localized to the activated region but extends to a surrounding tissue at rest over the distances regulated by the temperature-shielding effect of blood flow. This temperature-shielding effect quantifies the means by which cerebral blood flow prevents "temperature perturbations" from propagating away from the perturbed regions. For small activated regions, this effect also substantially suppresses the magnitude of the temperature response, making it especially important for small animal brains.
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Affiliation(s)
| | - Dmitriy A. Yablonskiy
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110
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Abstract
UNLABELLED In many situations, temporary artery occlusion is an integral component of aneurysm surgery. The use of temporary clip may allow safer and easier aneurysmal dissection and clipping. Several points, concerning the duration and overall risks of temporary occlusion and the method of choice for cerebral function monitoring have to be discussed. MATERIAL AND METHODS Non exhaustive review of neurosurgical literature. DISCUSSION Temporary clip application decreases the risk of intraoperative aneurysmal rupture. The analysis of data published in the literature showed that several questions remain open concerning the optimal method of neuroprotection and cerebral function monitoring, as well as the limit of occlusion duration. Other clinical trials are needed to assess the efficacy and safety of this technique.
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Affiliation(s)
- B Baussart
- Service de Neurochirurgie, Hôpital de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre Cedex
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Abstract
OBJECT Although clinical imaging defines the anatomical relationship between a brain tumor and the surrounding brain and neurological deficits indicate the neurophysiological consequences of the tumor, the effect of a brain tumor on vascular physiology is less clear. METHODS An infrared camera was used to measure the temperature of the cortical surface before, during, and after removal of a mass in 34 patients (primary brain tumor in 21 patients, brain metastases in 10 and falx meningioma, cavernous angioma, and radiation necrosis-astrocytosis in one patient each). To establish the magnitude of the effect on blood flow induced by the tumor, the images were compared with those from a group of six patients who underwent temporal lobectomy for epilepsy. In four cases a cerebral artery was temporarily occluded during the course of the surgery and infrared emissions from the cortex before and after occlusion were compared to establish the relationship of local temperature to regional blood flow. Discrete temperature gradients were associated with surgically verified lesions in all cases. Depending on the type of tumor, the cortex overlying the tumor was either colder or warmer than the surrounding cortex. Spatial reorganization of thermal gradients was observed after tumor resection. Temperature gradients of the cortex in patients with tumors exceeded those measured in the cortex of patients who underwent epilepsy surgery. CONCLUSIONS Brain tumors induce changes in cerebral blood flow (CBF) in the cortex, which can be made visible by performing infrared imaging during cranial surgery. A reduction in CBF beyond the tumor margin improves after removal of the lesion.
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Affiliation(s)
- Alexander M Gorbach
- National Institute of Neurological Disorders and Stroke, Bioengineering and Physical Science, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-5766, USA.
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Ibáñez J, Vilalta A, Mena MP, Vilalta J, Topczewski T, Noguer M, Sahuquillo J, Rubio E. [Intraoperative detection of ischemic brain hypoxia using oxygen tissue pressure microprobes]. Neurocirugia (Astur) 2004; 14:483-9; discussion 490. [PMID: 14710303 DOI: 10.1016/s1130-1473(03)70505-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE AND IMPORTANCE Detection of intraoperative ischemic events could lead to the resolution of their cause and to the prevention of the definitive establishment of a postoperative infarct. We want to illustrate the possibilities that intraoperative monitoring of oxygen tissue pressure (PtiO2) in critical areas during a neurosurgical vascular procedure offers, enhancing its reliability and immediacy in obtaining information about tissue oxygenation status as a marker of ischemia in the vascular territory at risk. CLINICAL PRESENTATION We report the case of a 32 year-old male with a deep arteriovenous malformation (AVM) localised in the insular region. The patient had been previously treated with radiosurgery without achieving a satisfactory result. INTERVENTION AVM removal was performed through a transylvian transinsular approach. PtiO2 was monitorised at the temporal pole (reference area) and at the posterior temporal region (risk area). Both probes maintained close tissue oxygenation levels until the last stage of the AVM resection when, during the coagulation of a supposed afferent vessel, a brisk fall of the oxygen tissue pressure in the posterior temporal region was detected. An ischemic infarct in this area was observed postoperatively. CONCLUSIONS PtiO2 monitoring has a high reliability in the detection of intraoperative tissue hypoxia. Data obtained could lead to early identification of these events and, whatever possible, to resolve this situation preventing the definitive establishment of an ischemic infarct.
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Affiliation(s)
- J Ibáñez
- Unidad de Neurotraumatología, Institut de Reccerca Vall d'Hebron. Universidad Autónoma. Barcelona. Spain
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Gorbach AM, Heiss J, Kufta C, Sato S, Fedio P, Kammerer WA, Solomon J, Oldfield EH. Intraoperative infrared functional imaging of human brain. Ann Neurol 2003; 54:297-309. [PMID: 12953262 DOI: 10.1002/ana.10646] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We hypothesized that it would be possible to detect the distribution of cortical activation by using a sensitive, rapid, high-resolution infrared imaging technique to monitor changes in local cerebral blood flow induced by changes in focal cortical metabolism. In a prospective study, we recorded in 21 patients the emission of infrared radiation from the exposed human cerebral cortex at baseline, during language and motor tasks, and during stimulation of the contralateral median nerve using an infrared camera (sensitivity 0.02 degrees C). The language and sensorimotor cortex was identified by standard mapping methods (cortical stimulation, median nerve somatosensory-evoked potential, functional magnetic resonance imaging), which were compared with infrared functional localization. The temperature gradients measured during surgery are dominated by changes in local cerebral blood flow associated with evoked functional activation. The distribution of the evoked temperature changes overlaps with, but extends beyond, functional regions identified by standard mapping techniques. The distribution observed via infrared mapping is consistent with distributed and complex functional representation of the cerebral cortex, rather than the traditional concept of discrete functional loci demonstrated by brief cortical stimulation during surgery and by noninvasive functional imaging techniques. By providing information on the spatial and temporal patterns of sensory-motor and language representation, infrared imaging may prove to be a useful approach to study brain function.
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Affiliation(s)
- Alexander M Gorbach
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke/NIH, Building 10, Bethesda, MD 20892, USA
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Gorbach A, Simonton D, Hale DA, Swanson SJ, Kirk AD. Objective, real-time, intraoperative assessment of renal perfusion using infrared imaging. Am J Transplant 2003; 3:988-93. [PMID: 12859534 DOI: 10.1034/j.1600-6143.2003.00158.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Allograft ischemia induces delayed graft function and is correlated with increasing rates of rejection. There is not currently a way to objectively measure the effects of ischemia in real-time, nor to relate therapies combating reperfusion injury with their intended effects. An infrared (IR) method utilizing a focal plane array detector camera was developed for real-time intraoperative IR imaging of renal allografts, and evaluated in a pilot trial to quantify perfusion in recipients of live (n = 8) and cadaveric donor (n = 5) allografts. Digital images were taken for 3-8 min postreperfusion. Image data were compared to ischemic time and allograft function to assess potential clinical relevance. Cold ischemic time ranged from 0.5 to 29 h and was bimodally distributed between living and cadaveric donors. Renal rewarming time (RT) as determined by IR imaging correlated with cold ischemic time (p < 0.001, R 2 = 0.81), and predicted the subsequent return of renal function with RT negatively correlated to the regression slopes of creatinine (p = 0.02, R 2 = 0.38) and BUN (p = 0.07, R 2 = 0.26). Intraoperative IR imaging noninvasively provides clinically relevant real-time whole kidney assessment of reperfusion. This technology may aide in the objective assessment of therapies designed to limit reperfusion injury, and allow for quantitative assessment of allograft ischemic damage.
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Affiliation(s)
- Alexander Gorbach
- Department of Diagnostic Radiology, Warren G. Magnuson Clinical Center, NIDDK, National Institutes of Health, Bethesda, MD, USA
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Ecker RD, Goerss SJ, Meyer FB, Cohen-Gadol AA, Britton JW, Levine JA. Vision of the future: initial experience with intraoperative real-time high-resolution dynamic infrared imaging. Technical note. J Neurosurg 2002; 97:1460-71. [PMID: 12507150 DOI: 10.3171/jns.2002.97.6.1460] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-resolution dynamic infrared (DIR) imaging provides intraoperative real-time physiological, anatomical, and pathological information; however, DIR imaging has rarely been used in neurosurgical patients. The authors report on their initial experience with intraoperative DIR imaging in 30 such patients. A novel, long-wave (8-10 microm), narrow-band, focal-plane-array infrared photodetector was incorporated into a camera system with a temperature resolution of 0.006 degrees C, providing 65,000 pixels/frame at a data acquisition rate of 200 frames/second. Intraoperative imaging of patients was performed before and after surgery. Infrared data were subsequently analyzed by examining absolute differences in cortical temperatures, changes in temperature over time, and infrared intensities at varying physiological frequencies. Dynamic infrared imaging was applied in a variety of neurosurgical cases. After resection of an arteriovenous malformation, there was postoperative hyperperfusion of the surrounding brain parenchyma, which was consistent with a loss of autoregulation. Bypass patency and increased perfusion of adjacent brain were documented during two of three extracranial-intracranial bypasses. In seven of nine patients with epilepsy the results of DIR imaging corresponded to seizure foci that had been electrocorticographically mapped preoperatively. Dynamic infrared imaging demonstrated the functional cortex in four of nine patients undergoing awake resection and cortical stimulation. Finally, DIR imaging exhibited the distinct thermal footprints of 14 of 16 brain tumors. Dynamic infrared imaging may prove to be a powerful adjunctive intraoperative diagnostic tool in the neurosurgical imaging armamentarium. Real-time assessment of cerebral vessel patency and cerebral perfusion are the most direct applications of this technology. Uses of this imaging modality in the localization of epileptic foci, identification of functional cortex during awake craniotomy, and determination of tumor border and intraoperative brain shift are avenues of inquiry that require further investigation.
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Affiliation(s)
- Robert D Ecker
- Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, Minnesota, USA
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