Cerebral Microcirculation: Progress and Outlook of Laser Doppler Flowmetry in Neurosurgery and Neurointensive Care

IF 1.9 4区 医学 Q3 HEMATOLOGY Microcirculation Pub Date : 2024-09-28 DOI:10.1111/micc.12884
Karin Wårdell, Johan Richter, Peter Zsigmond
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Abstract

Laser Doppler flowmetry (LDF) is a well-established technique for the investigation of tissue microcirculation. Compared to skin, the use in the human brain is sparse. The measurement of cerebral microcirculation in neurointensive care and during neurosurgery is challenging and requires adaptation to the respective clinical setting. The aim of the review is to present state of the art and progress in neurosurgery and neurointensive care where LDF has proven useful and can find clinical importance in the investigation of cerebral microcirculation. The literature in the field is summarized and recent technical improvements regarding LDF systems and fiber optical probe designs for neurosurgical and neurocritical care described. By combining two signals from the LDF unit, the measurement of the microcirculation (Perfusion) and gray whiteness (TLI) of the brain tissue, the full potential of the device is achieved. For example, a forward-looking LDF-probe detects high-risk hemorrhage areas and gray-white matter boundaries along intraoperative trajectories during stereotactic neurosurgery. Proof of principles are given for LDF as a guidance tool in deep brain stimulation implantation, brain tumor needle biopsies, and as long-term monitoring device in neurocritical care. With well-designed fiber optical probes, surgical fixation, and signal processing for movement reduction, LDF monitoring of the cerebral microcirculation is successful up to 10 days. The use of LDF can be combined with other physiological measurement techniques, for example, fluorescence spectroscopy for identification of glioblastoma during tumor surgery. Fiber optics can also be used during magnetic resonance imaging (MRI). Despite the many advantages, fiber optical LDF has not yet reached its full potential in clinical neuro-applications. Multicenter studies are required to further evaluate LDF in neurosurgery and neurointensive care. In conclusion, the present status of LDF in neurosurgery and neurointensive care has been reviewed. By combining Perfusion and TLI with tailored probe designs the full potential of LDF can be achived in measuring cerebral microcirculation. This includes guidance during DBS implantation and needle biopsies, and long-term monitoring in neurocritical care.

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脑微循环:激光多普勒血流测量在神经外科和神经重症监护中的应用进展与展望》。
激光多普勒血流测量仪(LDF)是一种用于研究组织微循环的成熟技术。与皮肤相比,该技术在人脑中的应用还很少。在神经重症监护和神经外科手术中测量脑微循环具有挑战性,需要适应相应的临床环境。本综述旨在介绍 LDF 在神经外科和神经重症监护中的应用现状和进展,LDF 已被证明在脑微循环研究中非常有用并具有重要的临床意义。文章概述了该领域的文献,并介绍了用于神经外科和神经重症监护的 LDF 系统和光纤探头设计的最新技术改进。通过结合 LDF 设备的两个信号,即脑组织微循环(灌注)和灰白色度(TLI)的测量,可以充分发挥设备的潜力。例如,在立体定向神经外科手术过程中,前视 LDF 探针可沿术中轨迹检测高风险出血区域和灰白质边界。LDF 作为脑深部刺激植入、脑肿瘤针刺活检的引导工具,以及作为神经重症监护的长期监测设备,其原理已得到验证。通过精心设计的光纤探头、手术固定和减少移动的信号处理,LDF 可成功监测大脑微循环长达 10 天。LDF 的使用可与其他生理测量技术相结合,例如在肿瘤手术过程中使用荧光光谱来识别胶质母细胞瘤。光纤还可用于磁共振成像(MRI)。尽管光纤 LDF 具有诸多优势,但其在临床神经应用中的潜力尚未得到充分发挥。需要进行多中心研究,进一步评估 LDF 在神经外科和神经重症监护中的应用。总之,本文回顾了 LDF 在神经外科和神经重症监护中的应用现状。通过将灌注和 TLI 与量身定制的探头设计相结合,LDF 可以在测量脑微循环方面充分发挥潜力。这包括在 DBS 植入和针刺活检过程中提供指导,以及在神经重症监护中进行长期监测。
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来源期刊
Microcirculation
Microcirculation 医学-外周血管病
CiteScore
5.00
自引率
4.20%
发文量
43
审稿时长
6-12 weeks
期刊介绍: The journal features original contributions that are the result of investigations contributing significant new information relating to the vascular and lymphatic microcirculation addressed at the intact animal, organ, cellular, or molecular level. Papers describe applications of the methods of physiology, biophysics, bioengineering, genetics, cell biology, biochemistry, and molecular biology to problems in microcirculation. Microcirculation also publishes state-of-the-art reviews that address frontier areas or new advances in technology in the fields of microcirculatory disease and function. Specific areas of interest include: Angiogenesis, growth and remodeling; Transport and exchange of gasses and solutes; Rheology and biorheology; Endothelial cell biology and metabolism; Interactions between endothelium, smooth muscle, parenchymal cells, leukocytes and platelets; Regulation of vasomotor tone; and Microvascular structures, imaging and morphometry. Papers also describe innovations in experimental techniques and instrumentation for studying all aspects of microcirculatory structure and function.
期刊最新文献
Models of Hydration Dependent Lymphatic Opening, Interstitial Fluid Flows and Ambipolar Diffusion. Pressure-Induced Microvascular Reactivity With Whole Foot Loading Is Unique Across the Human Foot Sole. Issue Information Microcirculatory Perfusion Disturbances During Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review. Cover Image
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