Laser speckle imaging for intraoperative assessment of cerebral autoregulation in patients with incidental and ruptured aneurysms
Olga Bordizhenko (Oldenburg; Damme), Patrick Dömer (Oldenburg), Simeon Helgers (Oldenburg), Timo Otterburg (Oldenburg), Heiko Dietzel (Damme), Johannes Woitzik (Oldenburg)
Cerebral autoregulation ensures a constant brain perfusion regardless of changes in systemic blood pressure. Impairments in cerebral autoregulation have been documented in various pathologies such as malignant stroke or subarachnoid hemorrhage (SAH) and identified as a predictor of poor outcomes. Early recognition of this dysfunction allows for effective adjustment of perfusion pressure-based treatment strategies. Existing data primarily focus on the postoperative phase during intensive care management. The detection of autoregulation disturbances in the acute phase remains insufficiently investigated. This study aimed to intraoperatively measure cerebral autoregulation using non-invasive Laser Speckle Imaging (LSI) in patients with SAH and unruptured aneurysms.
Intraoperative LSI imaging was performed using a Moor FLPI2 device. Patients with SAH or an unruptured aneurysm requiring surgical intervention were included. During LASCA imaging, a blood pressure difference of 10 mmHg MAP was induced, and the cerebral blood flow response was recorded using LSI. Cerebral autoregulation was determined at various positions distributed over the exposed cortex in all included patients.
In patients with SAH, there was an increase in cortical perfusion by 0.26% per mmHg MAP in response to an increase in MAP. In patients with unruptured aneurysms, this increase was only 0.12% per mmHg MAP. Analysis of different areas of the exposed cortex revealed stronger differences in autoregulation in SAH patients (IQR 0.61% per mmHg MAP) compared to patients with unruptured aneurysms (IQR 0.33% per mmHg MAP).
Cerebral autoregulation can be assessed and visualized in real-time using non-invasive LSI. In this pilot study, regional differences in autoregulation disturbances were identified between SAH patients and those with an unruptured aneurysm. Intraoperative LSI for determining cerebral autoregulation offers the opportunity to react to autoregulation disturbances in the early postoperative phase and adjust intensive care treatment strategies accordingly.
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