Intraoperative measurement of cortical oxygen saturation and blood volume adjacent to cerebral arteriovenous malformations using near-infrared spectroscopy

Siamak Asgari; Hans Joachim Röhrborn; Tobias Engelhorn; Barbara Fauser; Dietmar Stolke; H. Hunt Batjer; John Sinclair; Gary K. Steinberg; Chi Shing Zee; David A. Omahen; J. Max Findlay; Christopher S. Ogilvy

doi:10.1227/01.NEU.0000064801.78895.86

Intraoperative measurement of cortical oxygen saturation and blood volume adjacent to cerebral arteriovenous malformations using near-infrared spectroscopy

Siamak Asgari, Hans Joachim Röhrborn, Tobias Engelhorn, Barbara Fauser, Dietmar Stolke, H. Hunt Batjer, John Sinclair, Gary K. Steinberg, Chi Shing Zee, David A. Omahen, J. Max Findlay, Christopher S. Ogilvy

Research output: Contribution to journal › Article › peer-review

26 Scopus citations

Abstract

OBJECTIVE: Both cortical oxygen saturation (SaO₂) and cortical blood volume (BV) are related to regional cerebral blood flow. Among a series of patients with cerebral arteriovenous malformations, we examined the problem of hyperemia after embolization/resection or resection with the intraoperative application of near-infrared spectroscopy. METHODS: Cortical SaO₂ and BV (intracapillary total hemoglobin concentrations) were measured, with near-infrared spectroscopy, in areas adjacent to the arteriovenous malformation for 20 patients, before and after resection. The absolute values for both parameters and postexcision/preexcision ratios (P-P ratios) were determined. Data were correlated with multiple clinical and preoperative angiographic parameters. RESULTS: Before resection, the mean SaO₂ was 49 ± 16% and the mean BV was 12.65 ± 7.41 mg/ml. After resection, SaO₂ increased for 17 of 20 patients and BV increased for 18 of 20 patients. The differences between pre- and postexcision values for both parameters were observed to be statistically significant (P<0.01). The average P-P ratios were 1.5 ± 0.4 for SaO₂ and 1.7 ± 0.4 for BV. Correlation between the P-P ratios for the two parameters was good. The initial BV and the P-P ratios for both SaO₂ and BV were exclusively dependent on the extent of preoperative embolization. Postoperatively, two patients developed intracerebral hemorrhage or severe edema. Both demonstrated high P-P ratios for SaO₂ (2.3 and 2.1) and BV (1.6 and 2.1). CONCLUSION: Intraoperative near-infrared spectroscopy is able to detect the hyperemic status of adjacent cortex after arteriovenous malformation resection. However, staged therapy with embolization and surgery results in less hyperemia after resection. While two patients with hyperemic complications exhibited very large increases in SaO₂ and BV, we cannot refute the normal-perfusion pressure breakthrough theory.

Original language	English (US)
Pages (from-to)	1298-1306
Number of pages	9
Journal	Neurosurgery
Volume	52
Issue number	6
DOIs	https://doi.org/10.1227/01.NEU.0000064801.78895.86
State	Published - Jun 1 2003

Keywords

Blood volume
Cerebral arteriovenous malformation
Near-infrared spectroscopy
Oxygen saturation

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1227/01.NEU.0000064801.78895.86

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Asgari, S., Röhrborn, H. J., Engelhorn, T., Fauser, B., Stolke, D., Batjer, H. H., Sinclair, J., Steinberg, G. K., Zee, C. S., Omahen, D. A., Findlay, J. M., & Ogilvy, C. S. (2003). Intraoperative measurement of cortical oxygen saturation and blood volume adjacent to cerebral arteriovenous malformations using near-infrared spectroscopy. Neurosurgery, 52(6), 1298-1306. https://doi.org/10.1227/01.NEU.0000064801.78895.86

Asgari, S, Röhrborn, HJ, Engelhorn, T, Fauser, B, Stolke, D, Batjer, HH, Sinclair, J, Steinberg, GK, Zee, CS, Omahen, DA, Findlay, JM & Ogilvy, CS 2003, 'Intraoperative measurement of cortical oxygen saturation and blood volume adjacent to cerebral arteriovenous malformations using near-infrared spectroscopy', Neurosurgery, vol. 52, no. 6, pp. 1298-1306. https://doi.org/10.1227/01.NEU.0000064801.78895.86

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title = "Intraoperative measurement of cortical oxygen saturation and blood volume adjacent to cerebral arteriovenous malformations using near-infrared spectroscopy",

abstract = "OBJECTIVE: Both cortical oxygen saturation (SaO2) and cortical blood volume (BV) are related to regional cerebral blood flow. Among a series of patients with cerebral arteriovenous malformations, we examined the problem of hyperemia after embolization/resection or resection with the intraoperative application of near-infrared spectroscopy. METHODS: Cortical SaO2 and BV (intracapillary total hemoglobin concentrations) were measured, with near-infrared spectroscopy, in areas adjacent to the arteriovenous malformation for 20 patients, before and after resection. The absolute values for both parameters and postexcision/preexcision ratios (P-P ratios) were determined. Data were correlated with multiple clinical and preoperative angiographic parameters. RESULTS: Before resection, the mean SaO2 was 49 ± 16% and the mean BV was 12.65 ± 7.41 mg/ml. After resection, SaO2 increased for 17 of 20 patients and BV increased for 18 of 20 patients. The differences between pre- and postexcision values for both parameters were observed to be statistically significant (P<0.01). The average P-P ratios were 1.5 ± 0.4 for SaO2 and 1.7 ± 0.4 for BV. Correlation between the P-P ratios for the two parameters was good. The initial BV and the P-P ratios for both SaO2 and BV were exclusively dependent on the extent of preoperative embolization. Postoperatively, two patients developed intracerebral hemorrhage or severe edema. Both demonstrated high P-P ratios for SaO2 (2.3 and 2.1) and BV (1.6 and 2.1). CONCLUSION: Intraoperative near-infrared spectroscopy is able to detect the hyperemic status of adjacent cortex after arteriovenous malformation resection. However, staged therapy with embolization and surgery results in less hyperemia after resection. While two patients with hyperemic complications exhibited very large increases in SaO2 and BV, we cannot refute the normal-perfusion pressure breakthrough theory.",

keywords = "Blood volume, Cerebral arteriovenous malformation, Near-infrared spectroscopy, Oxygen saturation",

author = "Siamak Asgari and R{\"o}hrborn, {Hans Joachim} and Tobias Engelhorn and Barbara Fauser and Dietmar Stolke and Batjer, {H. Hunt} and John Sinclair and Steinberg, {Gary K.} and Zee, {Chi Shing} and Omahen, {David A.} and Findlay, {J. Max} and Ogilvy, {Christopher S.}",

year = "2003",

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doi = "10.1227/01.NEU.0000064801.78895.86",

language = "English (US)",

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pages = "1298--1306",

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T1 - Intraoperative measurement of cortical oxygen saturation and blood volume adjacent to cerebral arteriovenous malformations using near-infrared spectroscopy

AU - Asgari, Siamak

AU - Röhrborn, Hans Joachim

AU - Engelhorn, Tobias

AU - Fauser, Barbara

AU - Stolke, Dietmar

AU - Batjer, H. Hunt

AU - Sinclair, John

AU - Steinberg, Gary K.

AU - Zee, Chi Shing

AU - Omahen, David A.

AU - Findlay, J. Max

AU - Ogilvy, Christopher S.

PY - 2003/6/1

Y1 - 2003/6/1

N2 - OBJECTIVE: Both cortical oxygen saturation (SaO2) and cortical blood volume (BV) are related to regional cerebral blood flow. Among a series of patients with cerebral arteriovenous malformations, we examined the problem of hyperemia after embolization/resection or resection with the intraoperative application of near-infrared spectroscopy. METHODS: Cortical SaO2 and BV (intracapillary total hemoglobin concentrations) were measured, with near-infrared spectroscopy, in areas adjacent to the arteriovenous malformation for 20 patients, before and after resection. The absolute values for both parameters and postexcision/preexcision ratios (P-P ratios) were determined. Data were correlated with multiple clinical and preoperative angiographic parameters. RESULTS: Before resection, the mean SaO2 was 49 ± 16% and the mean BV was 12.65 ± 7.41 mg/ml. After resection, SaO2 increased for 17 of 20 patients and BV increased for 18 of 20 patients. The differences between pre- and postexcision values for both parameters were observed to be statistically significant (P<0.01). The average P-P ratios were 1.5 ± 0.4 for SaO2 and 1.7 ± 0.4 for BV. Correlation between the P-P ratios for the two parameters was good. The initial BV and the P-P ratios for both SaO2 and BV were exclusively dependent on the extent of preoperative embolization. Postoperatively, two patients developed intracerebral hemorrhage or severe edema. Both demonstrated high P-P ratios for SaO2 (2.3 and 2.1) and BV (1.6 and 2.1). CONCLUSION: Intraoperative near-infrared spectroscopy is able to detect the hyperemic status of adjacent cortex after arteriovenous malformation resection. However, staged therapy with embolization and surgery results in less hyperemia after resection. While two patients with hyperemic complications exhibited very large increases in SaO2 and BV, we cannot refute the normal-perfusion pressure breakthrough theory.

AB - OBJECTIVE: Both cortical oxygen saturation (SaO2) and cortical blood volume (BV) are related to regional cerebral blood flow. Among a series of patients with cerebral arteriovenous malformations, we examined the problem of hyperemia after embolization/resection or resection with the intraoperative application of near-infrared spectroscopy. METHODS: Cortical SaO2 and BV (intracapillary total hemoglobin concentrations) were measured, with near-infrared spectroscopy, in areas adjacent to the arteriovenous malformation for 20 patients, before and after resection. The absolute values for both parameters and postexcision/preexcision ratios (P-P ratios) were determined. Data were correlated with multiple clinical and preoperative angiographic parameters. RESULTS: Before resection, the mean SaO2 was 49 ± 16% and the mean BV was 12.65 ± 7.41 mg/ml. After resection, SaO2 increased for 17 of 20 patients and BV increased for 18 of 20 patients. The differences between pre- and postexcision values for both parameters were observed to be statistically significant (P<0.01). The average P-P ratios were 1.5 ± 0.4 for SaO2 and 1.7 ± 0.4 for BV. Correlation between the P-P ratios for the two parameters was good. The initial BV and the P-P ratios for both SaO2 and BV were exclusively dependent on the extent of preoperative embolization. Postoperatively, two patients developed intracerebral hemorrhage or severe edema. Both demonstrated high P-P ratios for SaO2 (2.3 and 2.1) and BV (1.6 and 2.1). CONCLUSION: Intraoperative near-infrared spectroscopy is able to detect the hyperemic status of adjacent cortex after arteriovenous malformation resection. However, staged therapy with embolization and surgery results in less hyperemia after resection. While two patients with hyperemic complications exhibited very large increases in SaO2 and BV, we cannot refute the normal-perfusion pressure breakthrough theory.

KW - Blood volume

KW - Cerebral arteriovenous malformation

KW - Near-infrared spectroscopy

KW - Oxygen saturation

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Intraoperative measurement of cortical oxygen saturation and blood volume adjacent to cerebral arteriovenous malformations using near-infrared spectroscopy

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