Spatially extended versus frontal cerebral near-infrared spectroscopy during cardiac surgery: a case series identifying potential advantages

Christian Rummel; Reto Basciani; Arto Nirkko; Gerhard Schroth; Monika Stucki; David Reineke; Balthasar Eberle; Heiko Kaiser

doi:10.1117/1.JBO.23.1.016012

22 January 2018 Spatially extended versus frontal cerebral near-infrared spectroscopy during cardiac surgery: a case series identifying potential advantages

Christian Rummel, Reto Basciani, Arto Nirkko, Gerhard Schroth, Monika Stucki, David Reineke, Balthasar Eberle, Heiko Kaiser

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Journal of Biomedical Optics, Vol. 23, Issue 1, 016012 (January 2018). https://doi.org/10.1117/1.JBO.23.1.016012

Abstract

Stroke due to hypoperfusion or emboli is a devastating adverse event of cardiac surgery, but early detection and treatment could protect patients from an unfavorable postoperative course. Hypoperfusion and emboli can be detected with transcranial Doppler of the middle cerebral artery (MCA). The measured blood flow velocity correlates with cerebral oxygenation determined clinically by near-infrared spectroscopy (NIRS) of the frontal cortex. We tested the potential advantage of a spatially extended NIRS in detecting critical events in three cardiac surgery patients with a whole-head fiber holder of the FOIRE-3000 continuous-wave NIRS system. Principle components analysis was performed to differentiate between global and localized hypoperfusion or ischemic territories of the middle and anterior cerebral arteries. In one patient, we detected a critical hypoperfusion of the right MCA, which was not apparent in the frontal channels but was accompanied by intra- and postoperative neurological correlates of ischemia. We conclude that spatially extended NIRS of temporal and parietal vascular territories could improve the detection of critically low cerebral perfusion. Even in severe hemispheric stroke, NIRS of the frontal lobe may remain normal because the anterior cerebral artery can be supplied by the contralateral side directly or via the anterior communicating artery.

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Christian Rummel, Reto Basciani, Arto Nirkko, Gerhard Schroth, Monika Stucki, David Reineke, Balthasar Eberle, and Heiko Kaiser "Spatially extended versus frontal cerebral near-infrared spectroscopy during cardiac surgery: a case series identifying potential advantages," Journal of Biomedical Optics 23(1), 016012 (22 January 2018). https://doi.org/10.1117/1.JBO.23.1.016012

Received: 20 March 2017; Accepted: 19 December 2017; Published: 22 January 2018

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