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(Stroke. 2006;37:1549.)
© 2006 American Heart Association, Inc.

Research Reports

Cortical Perfusion Measurement by Indocyanine-Green Videoangiography in Patients Undergoing Hemicraniectomy for Malignant Stroke

Johannes Woitzik, MD; Pablo G. Peña-Tapia, MD; Ulf C. Schneider, MD; Peter Vajkoczy, MD Claudius Thomé, MD

From the Department of Neurosurgery, University Hospital Mannheim, Faculty of Clinical Medicine Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany.

Correspondence to Dr Johannes Woitzik, Department of Neurosurgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. E-mail johannes.woitzik{at}nch.ma.uni-heidelberg.de

Background and Purpose— Assessment of cerebral perfusion during neurosurgical procedures would be beneficial to identify areas at risk and to guide placement of monitoring probes. Therefore, we have adapted near-infrared indocyanine-green (ICG) videoangiography to assess cortical perfusion intraoperatively.

Methods— ICG videoangiography was performed intraoperatively in 6 patients after decompressive hemicraniectomy for middle cerebral artery stroke. Flow maps of cortical perfusion were generated with IC-CALC 1.1 software by calculating the ratio of difference in fluorescence intensity and rise time.

Results— Excellent visualization of cerebral arteries, cortical perfusion and collateral circulation via leptomeningeal anastomoses could be demonstrated in all cases. Flow maps revealed high spatial resolution and showed heterogeneous maple-leaf-shaped hypoperfusion. 26.5±13.7% and 29.0±9.1% of the exposed cortical surface (141±18 cm²) demonstrated core and penumbral flow, respectively.

Conclusions— ICG videoangiography appears to be a valuable tool to precisely detect relative cortical tissue perfusion. Thus, it may provide useful research data on the pathophysiology of human stroke, help surgeons to maintain adequate brain perfusion intraoperatively, and simplify adequate placement of tissue probes to monitor critically hypoperfused brain tissue.

Key Words: angiography • cerebrovascular circulation • indocyanine green • stroke

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