Monitoring Techniques for Prevention of Procedure-Related Ischemic Damage in Aneurysm Surgery

Bacigaluppi, Susanna; Fontanella, Marco Maria; Manninen, Pirjo; Ducati, Alessando; Tredici, G; Gentili, Fred

doi:10.1016/j.wneu.2011.11.034

Cited by 41 publications

(37 citation statements)

References 120 publications

(142 reference statements)

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“…We generally agree with this idea, but our results suggested that in certain circumstances, SSEP's sensitivity may not be high enough. In addition, previous studies demonstrated the low reliability of SSEP in ACA and lenticulostriatal arteries of MCA while the majority of our ischemic complications resulted from these areas [1]. Previously, a postoperative motor deficit rate of around 5 % was reported in patients with an unruptured anterior circulation aneurysm [14,15].…”

Section: Discussionmentioning

confidence: 90%

Treatment outcomes of surgical clipping for unruptured anterior circulation aneurysm—single institute experiences in the era of neurophysiologic monitoring and endovascular treatment

Kim

Yeon

et al. 2015

Neurosurg Rev

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Recently, the treatment of intracranial aneurysms entered a new phase due to safe surgical tool such as neurophysiologic monitoring and challenged by endovascular treatment. To determine the safety of clipping surgery in the modern era, we reviewed our experiences of simple unruptured anterior circulation aneurysm surgery which is commonly performed in many places. We retrospectively reviewed 610 consecutive patients who were treated with surgical clipping under motor evoked potential (MEP) monitoring for a tiny to large anterior circulation aneurysm in a single institute between 2008 and 2012. MEP changes were identified in 40 cases (6.6 %). MEP deterioration was associated with remote site epidural hematoma (n = 1), anesthesia (n = 2), temporary clipping (n = 21), and permanent clipping (n = 16). Despite that no persistent MEP deterioration was noted after prompt corrective measures, 56 (9.2 %) patients showed symptomatic (n = 14) and asymptomatic (n = 42) radiologic abnormalities. Anterior cerebral artery (ACA) aneurysm was associated with a higher radiologic complication rate (Fisher's exact test, P < 0.05). Two (0.3 %) patients showed severe morbidity (mRS >2) at latest follow-up. MEP monitoring can be helpful in preventing postoperative motor deterioration but seems to have some limitations. Although the permanent morbidity rate was low, a significant clinical (2.3 %) or radiologic (9.2 %) abnormality rate was identified even in simple aneurysm clipping that should be taken into account when performing interdisciplinary treatment planning and patient counseling. Also, direct vascular monitoring or new neurophysiologic monitoring techniques are needed to reduce surgical complications, especially in ACA aneurysm surgery.

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Section: Discussionmentioning

confidence: 90%

Treatment outcomes of surgical clipping for unruptured anterior circulation aneurysm—single institute experiences in the era of neurophysiologic monitoring and endovascular treatment

Kim

Yeon

et al. 2015

Neurosurg Rev

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“…Thresholds for cerebral blood flow (CBF) are time dependent and vary with different specificity and sensitivity in terms of a probabilistic evolution following reperfusion, besides the fact that reported thresholds also vary between studies according to the imaging technique and the methods used for measurement: For an infarcted core, with a higher risk of necrosis, the upper threshold is about 12-14 mL/100 g/min, and for ischemic penumbra CBF is comprised between 12-14 and 18-22 mL/100 g/min; hypoperfusion is defined for CBF above 22 mL/100 g/min and below 55 mL/100 g/min [56]. The latter is characterized by hypoperfusion without significant impairment of basal metabolism, membrane polarization and thus cellular integrity [8,34,60]. This condition entails several adaptive reactions as increased oxygen extraction [32] related to acidosis [13], anaerobic glucose metabolism, glutamate release, decreased neurotransmission [45] and protein synthesis inhibition.…”

Section: Instrumental Detection Of Cerebral Vasospasmmentioning

confidence: 99%

“…Ischemia is another serious threat for these patients. Whereas its occurrence has been demonstrated in the ultra early phase after bleeding [55], its prevention represents a main issue not only during aneurysm treatment [8,92] but also in the weeks following SAH. Both cerebral vasospasm (CV) and delayed cerebral ischemia (DCI) have to be prevented, carefully monitored and eventually treated [75].…”

Section: Introductionmentioning

confidence: 99%

“…It occurs generally between days 3 and 14 after aneurysm rupture and is a major cause of delayed clinical deterioration. CV is a dynamic phenomenon with several stages: day 0 (triggering event: SAH), preliminary phase (days 1-3), initial vasospasm (days 3-4), peak (days [6][7][8], initial resolution of the vasospasm (days [10][11][12][13][14] and end of the spasm (day 21) [10,11,94,138]. While subclinical arterial narrowing is extremely frequent after SAH, CV becomes symptomatic only in about 30 % of patients [108,51].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of cerebral vasospasm and risk of delayed cerebral ischemia related to aneurysmal subarachnoid haemorrhage: an overview of available tools

et al. 2015

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In the first weeks following aneurysmal subarachnoid haemorrhage, cerebrovascular alterations may impact the outcome significantly. Diagnosis of cerebral vasospasm and detection of alterations at risk of delayed cerebral ischemia are key targets to be monitored in the post-acute phase. Available tools include clinical monitoring, as well as studies that can detect possible arterial narrowing, alterations of perfusion, metabolism and neurophysiology. Each technique is able to investigate possible vascular impairment and has different advantages and limits. All available techniques have been described. Among these, the most practical have been selected and compared for their peculiar characteristics. Based on this analysis, a flowchart to monitor these patients is finally proposed.

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“…[13][14][15][16] Recent reviews of these techniques during aneurysm clipping procedures concluded that none were completely reliable in all situations and that combining multiple techniques provided a more accurate picture of the hemodynamic state. 17,18 Optical flow measurement techniques based on dynamic light scattering have the potential to improve many of the shortcomings of the currently available methods. Laser speckle contrast imaging (LSCI) is an optical imaging technique that provides high spatiotemporal resolution and quantitative measurements of blood flow.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative laser speckle contrast imaging with retrospective motion correction for quantitative assessment of cerebral blood flow

et al. 2014

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Abstract. Although multiple intraoperative cerebral blood flow (CBF) monitoring techniques are currently available, a quantitative method that allows for continuous monitoring and that can be easily integrated into the surgical workflow is still needed. Laser speckle contrast imaging (LSCI) is an optical imaging technique with a high spatiotemporal resolution that has been recently demonstrated as feasible and effective for intraoperative monitoring of CBF during neurosurgical procedures. This study demonstrates the impact of retrospective motion correction on the quantitative analysis of intraoperatively acquired LSCI images. LSCI images were acquired through a surgical microscope during brain tumor resection procedures from 10 patients under baseline conditions and after a cortical stimulation in three of those patients. The patient's electrocardiogram (ECG) was recorded during acquisition for postprocess correction of pulsatile artifacts. Automatic image registration was retrospectively performed to correct for tissue motion artifacts, and the performance of rigid and nonrigid transformations was compared. In baseline cases, the original images had 25% AE 27% noise across 16 regions of interest (ROIs). ECG filtering moderately reduced the noise to 20% AE 21%, while image registration resulted in a further noise reduction of 15% AE 4%. Combined ECG filtering and image registration significantly reduced the noise to 6.2% AE 2.6% (p < 0.05). Using the combined motion correction, accuracy and sensitivity to small changes in CBF were improved in cortical stimulation cases. There was also excellent agreement between rigid and nonrigid registration methods (15/16 ROIs with <3% difference). Results from this study demonstrate the importance of motion correction for improved visualization of CBF changes in clinical LSCI images. © 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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Monitoring Techniques for Prevention of Procedure-Related Ischemic Damage in Aneurysm Surgery

Cited by 41 publications

References 120 publications

Treatment outcomes of surgical clipping for unruptured anterior circulation aneurysm—single institute experiences in the era of neurophysiologic monitoring and endovascular treatment

Treatment outcomes of surgical clipping for unruptured anterior circulation aneurysm—single institute experiences in the era of neurophysiologic monitoring and endovascular treatment

Diagnosis of cerebral vasospasm and risk of delayed cerebral ischemia related to aneurysmal subarachnoid haemorrhage: an overview of available tools

Intraoperative laser speckle contrast imaging with retrospective motion correction for quantitative assessment of cerebral blood flow

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