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Dimanche A, Goldberg J, Miller DR, Bervini D, Raabe A, Dunn AK. Laser speckle contrast imaging versus microvascular Doppler sonography in aneurysm surgery: A prospective study. World Neurosurg X 2024; 23:100377. [PMID: 38698836 PMCID: PMC11063637 DOI: 10.1016/j.wnsx.2024.100377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Objective This study aimed to compare microvascular Doppler sonography (MDS) and laser speckle contrast imaging (LSCI) for assessing vessel patency and aneurysm occlusion during microsurgical clipping of intracranial aneurysms. Methods MDS and LSCI were used after clip placement during six neurovascular procedures including six patients, and agreement between the two techniques was assessed. LSCI was performed in parallel or right after MDS evaluation. The Doppler response was assessed through listening while flow in the LSCI videos was evaluated by three blinded neurovascular surgeons after the surgery. Statistical analysis determined the agreement between the techniques in assessing flow in 18 regions of interest (ROIs). Results Agreement between MDS and LSCI in assessing vessel patency was observed in 87 % of the ROIs. LSCI accurately identified flow in 93.3 % of assessable ROIs, with no false positive or negative measurements. Three ROIs were not assessable with LSCI due to motion artifacts or poor image quality. No complications were observed. Conclusions LSCI demonstrated high agreement with MDS in assessing vessel patency during microsurgical clipping of intracranial aneurysms. It provided continuous, real-time, full-field imaging with high spatial resolution and temporal resolution. While MDS allowed evaluation of deep vascular regions, LSCI complemented it by offering unlimited assessment of surrounding vessels.
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Affiliation(s)
- Alexis Dimanche
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, TX, United States
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - David Bervini
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew K. Dunn
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, TX, United States
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Dimanche A, Bervini D, Miller DR, Schär A, Goldberg J, Raabe A, Dunn AK. Cortical perfusion measurements with laser speckle contrast imaging during adenosine induced cardiac arrest for aneurysm clipping: a case report. Acta Neurochir (Wien) 2024; 166:27. [PMID: 38261093 DOI: 10.1007/s00701-024-05925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/17/2023] [Indexed: 01/24/2024]
Abstract
Adenosine induced cardiac arrest (AiCA) is one of the methods used to facilitate microsurgical aneurysm clipping by providing more visibility and less pressure in the aneurysmal sac and neighboring vessels. We report the use of laser speckle contrast imaging (LSCI) during AiCA to monitor the changes in pulsation and perfusion on the cortical surface during adenosine induced cardiac arrest for aneurysm clipping surgery. Application of this technology for perfusion monitoring may improve workflow and surgical guidance and provide valuable feedback continuously throughout the procedure. ClinicalTrials.gov identifier: NCT0502840.
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Affiliation(s)
- Alexis Dimanche
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - David Bervini
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Andreas Schär
- Department Anaesthesiology & Pain Therapy, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew K Dunn
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA.
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Dimanche A, Miller DR, Goldberg J, Raabe A, Dunn AK, Bervini D. Continuous hemodynamics monitoring during arteriovenous malformation microsurgical resection with laser speckle contrast imaging: case report. Front Surg 2023; 10:1285758. [PMID: 38162090 PMCID: PMC10757834 DOI: 10.3389/fsurg.2023.1285758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
AVM surgery is challenging due to progressive and often unforeseeable flow changes during its resection which involve both the AVM and the surrounding brain tissue. Hence, accurate monitoring of blood flow is crucial to minimize complications and improve outcomes. The following case report illustrates the usefulness of complimentary non-invasive tools that can provide real time blood flow assessment. We present a case demonstrating the application of laser speckle contrast imaging (LSCI) in evaluating vessel flow dynamics during AVM surgery. A 30-year-old female presented with sudden headaches, nausea, vomiting, and vertigo. Emergency imaging revealed a ruptured cerebellar AVM necessitating surgical intervention. LSCI was integrated into the surgical workflow, providing continuous visualization of relative cerebral blood flow (rCBF) of vessels surrounding the AVM. Before AVM resection, LSCI measurements revealed the arterialized vasculature supplying the AVM nidus; measurements after AVM resection showed significant hemodynamic changes including normal flow in the initially arterialized AVM draining veins and adjacent arterial branches. LSCI also detected blood flow alterations during temporary occlusion, enabling assessment of downstream vascular regions. In conclusion, we provide an example supporting the utility of LSCI for real-time hemodynamic monitoring during AVM resection surgery. LSCI offers non-invasive, continuous, and immediate blood flow information, complementing conventional imaging methods like indocyanine green angiography. Additionally, our findings suggest that LSCI has the potential to provide a non-invasive means of identifying the specific superficial vessel branches or cortical areas that receive blood supply from a particular vessel.
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Affiliation(s)
- Alexis Dimanche
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, United States
| | | | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew K. Dunn
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, United States
| | - David Bervini
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Goldberg J, Miller DR, Dimanche A, Kissling C, Müller T, Müller MD, Jesse CM, Murek M, Bervini D, Dunn AK, Raabe A. Intraoperative Laser Speckle Contrast Imaging to Assess Vessel Flow in Neurosurgery: A Pilot Study. Neurosurgery 2023:00006123-990000000-00974. [PMID: 38032222 DOI: 10.1227/neu.0000000000002776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Laser speckle contrast imaging (LSCI) has emerged as a promising tool for assessment of vessel flow during neurosurgery. We aimed to investigate the feasibility of visualizing vessel flow in the macrocirculation with a new fully microscope-integrated LSCI system and assess the validity and objectivity of findings compared with fluorescence angiography (FA). METHODS This is a single-center prospective observational study enrolling adult patients requiring microsurgical treatment for brain vascular pathologies or brain tumors. Three independent raters, blinded toward findings of FA, reviewed regions of interest (ROIs) placed in exposed vessels and target structures. The primary end point was the validity of LSCI for assessment of vessel flow as measured by the agreement with FA. The secondary end point was objectivity, measured as the inter-rater agreement of LSCI findings. RESULTS During 18 surgical procedures, 23 observations using FA and LSCI were captured simultaneously. Using LSCI, vessel flow was assessable in 62 (86.1%) and not assessable in 10 (13.9%) ROIs. The agreement between LSCI and FA was 86.1%, with an agreement coefficient of 0.85 (95% CI: 0.75-0.94). Disagreement between LSCI and FA was observed in the 10 ROIs that were not assessable. The agreement between ROIs that were assessable using LSCI and FA was 100%. The inter-rater agreement of LSCI findings was 87.9%, with an agreement coefficient of 0.86 (95% CI: 0.79-0.94). CONCLUSION Fully microscope-integrated LSCI is feasible and has a high potential for clinical utility. Because of its characteristics, LSCI can be viewed as a full-field visual micro-Doppler that can be used as a complementary method to FA for assessing vessel flow during neurosurgery. Despite technical limitations related to the early development phase of the fully microscope-integrated system, we demonstrated reasonable validity and objectivity of findings compared with FA. Further research and refinement of the system may enhance its value in neurosurgical applications.
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Affiliation(s)
- Johannes Goldberg
- Department of Neurosurgery and Stroke Research Center Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Alexis Dimanche
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Cédric Kissling
- Department of Neurosurgery and Stroke Research Center Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Timothy Müller
- Department of Neurosurgery and Stroke Research Center Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mandy D Müller
- Department of Neurosurgery and Stroke Research Center Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christopher Marvin Jesse
- Department of Neurosurgery and Stroke Research Center Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Murek
- Department of Neurosurgery and Stroke Research Center Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery and Stroke Research Center Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew K Dunn
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Andreas Raabe
- Department of Neurosurgery and Stroke Research Center Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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