Measurement of Regional Cerebral Blood Flow by Near Infrared Spectroscopy and Indocyanine Green Dye Dilution

  • E. Keller
  • A. Nadler
  • H. Alkadhi
Conference paper

Abstract

After subarachnoid hemorrhage (SAH), the complex changes of cerebral hemody­namics and oxygenation pattern with the development of cerebral vasospasm are underestimated if transcranial Doppler (TCD) monitoring and angiography are considered singularly. The role of TCD in predicting symptomatic cerebral vaso-spasm is limited to the cases in which very high blood flow velocities are detected [1]. Discrepancies between radiographic findings and delayed ischemic deficits may depend on the relationship between local cerebral oxygen-requirement and -deliv­ery, which only can be determined if cerebral blood flow (CBF) and cerebral oxy­gen extraction can be estimated. Low CBF has been identified as an independent predictor of poor outcome after SAH [2]. Nevertheless the established methods for bedside measurement of CBF with inert tracers such as the nitrous oxide dilution method or the 133Xenon dilution technique are technically difficult and time con­suming [3, 4]. Stable xenon-enhanced computed tomography (CT), positron emis­sion tomography (PET) and magnetic resonance spectroscopy are powerful re­search tools [5–8], but require that the patient is transported to the imaging unit, which carries a potential high risk. Recently a new double indicator dilution tech­nique for bedside monitoring of CBF in combination with jugular bulb oximetry became available [9, 10]. Nevertheless first examinations in patients with SAH show that the sensitivity of the new method to detect cerebral vasospasm may be limited by the technique measuring only global CBF values [11]. TCD and jugular bulb oxi­metry using optical fibers [12] give indices that can be related to changes in CBF but do not measure true flows. Furthermore, techniques based on jugular bulb cat­heters, represent only global cerebral oxygenation and perfusion. A decrease in the jugular bulb oxygen saturation (SjvO2) may be useful only in detecting severe prox­imal cerebral vasospasm, leading to significant reduction of hemispheric blood flow. The sensitivity of SjvO2 to detect smaller ischemic areas secondary to cerebral vasospasm of single vessels is limited [11]. In cases of distal arterial narrowing, techniques measuring regional values of local cortical perfusion, representing se­lected vascular territories, may be more sensitive. Monitoring of partial pressure of brain tissue oxygen (PbtO2) is suitable for detecting focal changes in cerebral oxy­genation pattern [13]. PbtO2-monitoring, nevertheless, using intraparenchymatous brain catheters is an invasive method, giving accurate results only in sedated pa­tients. Moreover, cerebral vasospasm may occur in different vascular territories not observed with the PbtO2-monitoring. The limitations of the available techniques encourage the development of a practical method for measuring regional cerebral perfusion non invasively in different vascular territories.

Keywords

Cerebral Blood Flow Cerebral Blood Volume Cerebral Vasospasm Regional Cerebral Blood Flow Near Infrared Spectroscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • E. Keller
  • A. Nadler
  • H. Alkadhi

There are no affiliations available

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