Alterations of cerebral microcirculation in peritumoral edema: feasibility of in vivo sidestream dark-field imaging in intracranial meningiomas

Abstract

BACKGROUND Intra-cranial meningiomas display a variable amount of peri-tumoral brain edema (PTBE), which can significantly impact peri-operative morbidity. The role of microcirculatory disturbances in the pathogenesis of PTBE is still debated. The aim of this study was to microscopically demonstrate and intra-operatively quantify, for the first time, the alterations to microcirculation in PTBE using sidestream dark field (SDF) imaging. METHODS Adult patients with WHO grade I meningiomas were recruited over a 9-month period and divided into 2 groups depending on the absence (NE group) or the presence (E group) of PTBE. In vivo intra-operative microcirculation imaging was performed in the peri-tumoral area before and after microsurgical resection. RESULTS Six patients were included in the NE group and 6 in the E group. At the baseline in the NE group, there was a minor decrease in microcirculatory parameters compared to normal reference values, which was probably due to mass effect. In contrast, microcirculatory parameters in the E group were significantly altered, affecting both vessel density and blood flow values, with a drop of approximately 50% of normal values. Surgical resection resulted in a quasi-normalization of microcirculation parameters in the NE group, whereas in the E group, even if all parameters statistically significantly improved, post-resection values remained considerably inferior to those of the normal reference pattern. CONCLUSION Our study confirmed significant alterations of microcirculatory parameters in PTBE in meningiomas. Further in vivo SDF imaging studies may explore the possible correlation between the severity of these microcirculatory alterations and the post-operative neurological outcome.

Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions

“…Moreover, through the means of perfusion assessment, the glioma grade can be predicted [ 170 , 171 , 172 ]. With respect of the techniques used to monitor CBF intra-operatively that are increasingly reported [ 173 ], these have been recently reviewed by Tahhan et al [ 174 ].…”

Regeneration and Assessment of the Endothelial Glycocalyx To Address Cardiovascular Disease

“…Thus, to expand the capabilities and benefits offered by SDF, it is advisible to explore ways to expand this technology for visualization of the vasculature deeper within the body, specifically regions susceptible to GCX degradation and plaque formation such as the branches of the carotid and coronary arteries, as well as the aortic arch. For example, Berhouma et al used SDF imaging intraoperatively in order to visualize the intracranial meningiomas during surgery . This has been one of the first successful attempts to use SDF imaging beyond the sublingual vasculature, though this study did not specifically look at the GCX .…”

“…The first such attempt, made by Bec et al, combined ultrasound with multispectral fluorescence lifetime imaging (FLIM) in order to gather morphological and biochemical information, as well as characterize atherosclerotic plaque pathophysiology on the swine coronary vessels in vivo . Unfortunately, the method does not currently allow for detection of the GCX, but this could change if it were possible to integrate the technology of SDF and GlycoCheck with this catheter approach. , …”

“…For example, Berhouma et al used SDF imaging intraoperatively in order to visualize the intracranial meningiomas during surgery. 129 This has been one of the first successful attempts to use SDF imaging beyond the sublingual vasculature, though this study did not specifically look at the GCX. 129 An alternative expansion of SDF to the deeper vasculature may lie in a probe technology delivered through a catheter intravascularly.…”

“…129 This has been one of the first successful attempts to use SDF imaging beyond the sublingual vasculature, though this study did not specifically look at the GCX. 129 An alternative expansion of SDF to the deeper vasculature may lie in a probe technology delivered through a catheter intravascularly. The first such attempt, made by Bec et al, combined ultrasound with multispectral fluorescence lifetime imaging (FLIM) in order to gather morphological and biochemical information, as well as characterize atherosclerotic plaque pathophysiology on the swine coronary vessels in vivo.…”