Direct observation during surgery shows preservation of cerebral microcirculation in patients with traumatic brain injury

Pérez-Bárcena, Jon; Romay, E.; Llompart‐Pou, Juan Antonio; Ibáñez, Javier; Brell, Marta; Llinás, Pedro; González, Elsa Marina Álvarez; Merenda, Amedeo; İnce, Can; Bullock, Ross

doi:10.1016/j.jns.2015.03.044

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…Other vascular findings in TBI patients include loss of autoregulatory capacity 22 , decreased cerebrovascular reactivity 23,24 , and persistent blood brain barrier leakage 25 . Further, in severe human TBI direct observation of the peri-contusional vasculature reported decreased vessel density but no apparent alteration in flow 13 .…”

Section: Discussionmentioning

confidence: 97%

“…The morphological underpinnings that provide the basis for the modified cerebrovasculature after TBI have not been well described. In patients with severe TBI, post-mortem tissue analysis revealed collapsed, truncated and reduced vascular elements 13 . Similarly, reduced vascular density during the acute phase in moderate and severe animal models of TBI results in functional decrements 10,14 .…”

Section: Introductionmentioning

confidence: 99%

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Traumatic brain injury results in acute rarefication of the vascular network

Obenaus

Orantes

et al. 2017

Sci Rep

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The role of the cerebrovascular network and its acute response to TBI is poorly defined and emerging evidence suggests that cerebrovascular reactivity is altered. We explored how cortical vessels are physically altered following TBI using a newly developed technique, vessel painting. We tested our hypothesis that a focal moderate TBI results in global decrements to structural aspects of the vasculature. Rats (naïve, sham-operated, TBI) underwent a moderate controlled cortical impact. Animals underwent vessel painting perfusion to label the entire cortex at 1 day post TBI followed by whole brain axial and coronal images using a wide-field fluorescence microscope. Cortical vessel network characteristics were analyzed for classical angiographic features (junctions, lengths) wherein we observed significant global (both hemispheres) reductions in vessel junctions and vessel lengths of 33% and 22%, respectively. Biological complexity can be quantified using fractal geometric features where we observed that fractal measures were also reduced significantly by 33%, 16% and 13% for kurtosis, peak value frequency and skewness, respectively. Acutely after TBI there is a reduction in vascular network and vascular complexity that are exacerbated at the lesion site and provide structural evidence for the bilateral hemodynamic alterations that have been reported in patients after TBI.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Traumatic brain injury results in acute rarefication of the vascular network

Obenaus

Orantes

et al. 2017

Sci Rep

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“…SDF imaging relies on a stroboscopic light-emitting diode ring-based modality integrated in a handheld device ( Figure 2A ). 24 , 29–32 This device is composed of a light guide with a magnifying lens and an analogue embedded camera. The illumination comes from a green light with a 530 nm wavelength that is specifically absorbed by hemoglobin.…”

Section: Methodsmentioning

confidence: 99%

“… 7 , 10 , 11 , 14–23 Nevertheless, these macroscopic alterations of peritumoral circulation may not reflect the anomalies at the level of the microcirculation. 24 , 25 The recent development of handheld noninvasive videomicroscopic techniques has offered new possibilities in the investigation of microcirculation. 26 , 27 …”

mentioning

confidence: 99%

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

Berhouma

Picart

Dumot

et al. 2020

Neuro-Oncology Advances

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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.

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“…However, advances in reflection optical imaging have facilitated intraoperative imaging of cerebral microcirculation on the brain surface. 6 However, such two-dimensional methods are unable to discriminate planes within a three-dimensional (3-D) volume. Real-time 3-D imaging in tissue can be achieved using optical coherence tomography (OCT) 7,8 and vasculature can be differentiated from static tissue using a variety of processing algorithms, collectively called optical coherence angiography (OCA), 9 which has been applied specifically to neuroscience 10 and ophthalmology.…”

Section: Introductionmentioning

confidence: 99%

Heart-rate sensitive optical coherence angiography for measuring vascular changes due to posttraumatic brain injury in mice

et al. 2017

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, "Heart-rate sensitive optical coherence angiography for measuring vascular changes due to posttraumatic brain injury in mice," J. Biomed. Opt. Abstract. Traumatic brain injury (TBI) results in direct vascular disruption, triggering edema, and reduction in cerebral blood flow. Therefore, understanding the pathophysiology of brain microcirculation following TBI is important for the development of effective therapies. Optical coherence angiography (OCA) is a promising tool for evaluating TBI in rodent models. We develop an approach to OCA that uses the heart-rate frequency to discriminate between static tissue and vasculature. This method operates on intensity data and is therefore not phase sensitive. Furthermore, it does not require spatial overlap of voxels and thus can be applied to preexisting datasets for which oversampling may not have been explicitly considered. Heart-rate sensitive OCA was developed for dynamic assessment of mouse microvasculature post-TBI. Results show changes occurring at 5-min intervals within the first 50 min of injury. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Direct observation during surgery shows preservation of cerebral microcirculation in patients with traumatic brain injury

Cited by 11 publications

References 26 publications

Traumatic brain injury results in acute rarefication of the vascular network

Traumatic brain injury results in acute rarefication of the vascular network

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

Heart-rate sensitive optical coherence angiography for measuring vascular changes due to posttraumatic brain injury in mice

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