Assessment of Hemodynamic Changes and Hyperperfusion Risk After Extracranial-to-Intracranial Bypass Surgery Using Intraoperative Indocyanine Greene-Based Flow Analysis

作者：Rennert Robert C; Strickland Ben A; Ravina Kristine; Bakhsheshian Joshua; Russin Jonathan J^*

来源：World Neurosurgery, 2018, 114: 352-360.

DOI：10.1016/J.WNEU.2018.03.189

• Cerebral bypass
• Flow 800
• Hyperperfusion syndrome

BACKGROUND: Intraoperative blood flow assessments during cerebral bypass would ideally assess vessel patency, downstream perfusion, and risk of postoperative hyperperfusion syndrome (HPS). Previous studies using indocyanine green-based flow analyses (ICG-BFA) have identified multiple parameters that can intraoperatively track bypass-related changes in cerebral perfusion and potentially predict postoperative risk of HPS. Herein, we determine the most robust parameter and anatomic location for intraoperative ICG-BFA assessment of bypass-related perfusion changes and prediction of postoperative risk of HPS.
METHODS: Retrospective analysis of an institutional review board-approved prospective database identified patients undergoing superficial temporal artery-to-middle cerebral artery bypass. Demographic and clinical information, as well as manually calculated and automated pre-and postbypass intraoperative ICG-BFA data from cortical, arterial, and venous regions of interest were recorded and analyzed.
RESULTS: Seven patients underwent superficial temporal artery-to-middle cerebral artery bypass (4 Moyamoya, 3 carotid occlusions). Average age was 48.2 +/- 13.9 years (3 female, 4 male). Although all parameters measured showed trends toward improvement postbypass, only changes in arterial and venous automated ICG-BFA slope (also known as blood flow index [maximum intensity/rise time]) reached significance. None of the patients experienced symptomatic HPS, despite 5 of 7 (71.4%) having an increased HPS risk based on previously published ICG-BFA data.
CONCLUSIONS: ICG-BFA has utility for the intraoperative assessment of bypass-related changes in cerebral perfusion, with automated blood flow index being the most robustly affected parameter. Although previously published ICG-BFA indices did not predict the development of symptomatic postoperative HPS, larger-scale studies correlating observed ICG-BFA changes with risk of HPS are warranted.

• 出版日期2018-6