Visualisation of cortical pO(2) during an epidural mass lesion in rodents.

Monitoring p(bt)O(2) is a valuable supplemental -procedure for neurocritically ill patients. Here, we utilise an opto-chemical method for measuring cortical pO(2) during a reversibly introduced epidural mass lesion in a rat model. The sensor was placed in a cortical window of 17 ventilated Wistar rats. Inflating the balloon device over the contralateral hemisphere increased ICP. Physiological parameters and cortical pO(2) were recorded. The ICP increased from 6.2 ± 4.6 to 44.6 ± 12.6 mmHg (p < 0.001). Cortical pO(2) over arterioles changed from 28.9 ± 2.1 to 19.0 ± 2.1 mmHg (p < 0.001), over venules from 14.8 ± 1.2 to 9.9 ± 1.5 mmHg (p = 0.002) and over parenchyma from 4.1 ± 0.7 to 2.4 ± 0.8 mmHg respectively (p < 0.001), while basic physiological parameters remained constant (p > 0.05). During baseline, arterial pO(2) correlated significantly with cortex arteriole and venole pO(2), but not with cortex parenchyma pO(2). While ICP was raised, cortical pO(2) did not correlate with arterial pO(2). In this model, a moderate epidural mass lesion causes a significant decrease in cortical pO(2). Cortex parenchyma pO(2) appeared to be independent from arterial pO(2). The correlation of cortex vessel pO(2) with arterial pO(2) disappeared during the epidural mass lesion. These findings show the capability of the device to elucidate the behaviour of functionally different cortex areas at pathophysiological conditions.

Discrepancies between the MRI- and the electrophysiologically defined subthalamic nucleus.

BACKGROUND: The aim of our study was to evaluate discrepancies between the electrophysiologically and MRI-defined subthalamic nucleus (STN) in order to contribute to the ongoing debate of whether or not microelectrode recording (MER) provides additional information to image-guided targeting in deep brain stimulation. METHODS: Forty-four STNs in 22 patients with Parkinson's disease were investigated. The three-dimensional MRI-defined STN was derived from segmentations of axial and coronal T2-weighted images. The electrophysiological STNs were generated from intraoperative MERs in 1,487 locations. The stereotactical coordinates of positive and negative STN recordings were re-imported to the planning software, where a three-dimensional reconstruction of the electrophysiological STN was performed and fused to the MRI data set. The estimated borders of the MRI- and MER-STN were compared. For statistical analysis Student's t, Mann-Whitney rank sum and Fisher's exact tests were used. RESULTS: MER-STN volumes, which were found outside the MRI-STN, ranged from 0 mm(3) to 87 mm(3) (mean: 45 mm(3)). A mean of 44% of the MER-STN volumes exceeded the MRI-STN (maximum: 85.1%; minimum: 15.1 %); 53.4% (n = 793) of the microelectrode recordings were concordant and 46.6% (n = 694) discordant with the MRI-defined anatomical STN. Regarding the dorsal borders, we found discrepancies between the MER- and MRI-STN of 0.27 mm (= mean; SD: 0.51 mm) on the first operated side and 1.51 mm (SD: 1.5 mm) on the second (p = 0.010, t-test). CONCLUSIONS: MER provides additional information to high-resolution anatomical MR images and may help to detect the amount and direction of brain shift.

Radial oxygen gradients over rat cortex arterioles.

PURPOSE: We present the results of the visualisation of radial oxygen gradients in rats' cortices and their potential use in neurocritical management. METHODS: PO2 maps of the cortex of ten sedated, intubated and controlled ventilated Wistar rats were obtained with a camera (SensiMOD, PCO, Kelheim, Germany). Those pictures were analysed and edited by a custom-made software. A virtual matrix, designed to evaluate the cortical O2 partial pressure, was placed vertically to the artery under investigation, and afterwards multiple regions of interest were measured (width 10 pixels, length 15-50 pixels). The results showed a map of the cerebral oxygenation, which allowed us to calculate radial oxygen gradients over arterioles. Three groups were defined according to the level of the arterial pO2: PaO2 < 80, PaO2 80-120 and PaO2 > 120. Gradients were analysed from the middle of the vessel to its border (1), from the border into the parenchyma next to the vessel (2) and a combination of both (3). RESULTS: Gradient 1 showed significantly different cortical pO2 values between the three different groups. The mean pO2 values were 2.62, 5.29 and 5.82 mmHg/mm. Gradient 2 measured 0.56, 0.90 and 1.02 mmHg/mm respectively. Gradient 3 showed significant results between the groups with values of 3.18, 6.19 and 6.84 mmHg/mm. CONCLUSION: Using these gradients, it is possible to describe and compare the distribution of oxygen to the brain parenchyma. With the presented technique, it is possible to detect pO2 changes in the oxygen supply of the brain cortex.

The prognostic value of NSE and S100B from serum and cerebrospinal fluid in patients with spontaneous subarachnoid hemorrhage.

Neuron-specific enolase (NSE) and S100B protein have been shown to be increased in cerebrospinal fluid (CSF) and serum of patients suffering from subarachnoid hemorrhage. This study was designed to evaluate the accuracy of NSE and S100B from CSF and serum for the prognosis of outcome and the detection of cerebral infarction, vasospasm and intracranial hypertension. In 55 patients with spontaneous subarachnoid hemorrhage and requiring external ventricular drainage the concentrations of NSE and S100B were determined daily from the serum and the CSF from admission until day 8. At ICU discharge patients' outcome was assessed by the Glasgow outcome scale and occurrence of cerebral infarction, vasospasm and intracranial hypertension were registered. Mean and peak values of each parameter for each patient were calculated. For accuracy assessment receiver operating characteristics were used. Bad outcome (Glasgow outcome scale 1 to 3) was found in 33 patients. Cerebral infarction, vasospasm, and intracranial hypertension were found in 31 (56%), 34 (62%), and 36 (65%) patients. Mean and peak values of NSE CSF (P<0.001), S100B CSF (P<0.001), and S100B serum (P<0.001) but not of NSE serum provided the ability to distinguish between patients with good and bad outcome. The accuracy of NSE CSF and S100B CSF did not differ significantly from that of S100B serum. NSE CSF (P<0.001), S100B CSF (P<0.001), and S100B serum (P<0.001) allowed the detection of cerebral infarction and intracranial hypertension. Cerebral vasospasm was detected by none of the parameters. In conclusion, NSE CSF, S100B CSF, and S100B serum provide similar prognostic values for outcome, intracranial hypertension and cerebral infarction. Significantly lower accuracy was found for NSE serum.

Non-invasive measurement of the superficial cortical oxygen partial pressure.

We present a non invasive fluorescein based method to measure and visualise the partial oxygen pressure of the rat cortex in a 2D picture. We studied 10 Wistar rats. A trepanation was done over the hemisphere and the dura was opened. A PMMA cylinder with a calibrated optical membrane was fixed over the surface of the brain. The CCD camera with the light source is placed over the cylinder. This allows the generation of two-dimensional maps of the pO2 pressure. Using the white light picture we defined regions of interest (ROI) in an artery, vein, parenchyma and an overall ROI. For every ROI a mean emission value was calculated. We increased, stepwise, the FiO2 from 30% up to 100%. Thereafter we established ventilation with an FiO2 of 30% and induced a stepwise hypo- and hyperventilation. The ROI's showed significantly different pO2 values. The apO2 showed a good correlation to the pO2 in the ROIs. This new set up seems to give reliable absolute pO2 values of the brain surface. This method seems to be able for the first time to give a non invasive pO2 map of the brain surface reflecting oxygenation and ventilation effects.

Simultaneous imaging of cortical partial oxygen pressure and anatomic structures using a transparent optical sensor foil.

BACKGROUND/PURPOSE: Reliable information of cerebral oxygenation is-besides the monitoring of the intracranial pressure-of eminent interest when treating patients with brain injuries. In this study, we introduce a new, fast, and sensitive method capable of determining the cortical partial oxygen pressure on the surface of the cortex using a special sensor foil. METHODS: The introduced method exploits the O2-dependent phosphorescence of a thin sensor foil, which is excited by a short light-emitting diode flash. The optical signal is registered by a charge-coupled device camera and analyzed with PC-based software. The adequacy of this method was tested in 10 animals. The sensor device was placed directly over the cortex after craniotomy and removal of the dura. Arterial oxygen pressure was systematically varied by modifying the ventilation gas mixture. A total of 225 measurements were performed within 4 regions of interest. RESULTS: Obtained results were sufficient in each case. The pO2 over the cortex correlated well with arterial pO2. Measurements over arteries showed a correlation coefficient of 0.72 (P<0.001), over veins 0.58 (P<0.001), over cortical parenchyma 0.46 (P<0.001), and in a larger region of interest containing vessels and cortical tissue 0.59 (P<0.001). The frequency of the measurements was 7 Hz with a single measurement covering an area of 30 x 30 microm. CONCLUSIONS: For the first time, nearly online pO2 maps of a brain cortex can be generated, allowing simultaneously also separate measurements over distinct anatomic structures yielding a good spatial resolution.

A new semi-invasive method for two dimensional pO2 measurements of cortical structures.

BACKGROUND: Measuring brain oxygenation in patients with TBI or SAH is of major interest. We present a new semi-invasive method for two dimensional measurements of cortical pO2. METHODS: For this feasibility study, a porphyrin containing sensor foil was placed directly on the cortex of intubated and variably ventilated Wistar rats. The sensor was excited with a light pulse and pictures of the foil's pO2 dependant emissions were captured with a CCD camera. After online data processing, two-dimensional maps of cortex oxygenation were displayed and analyzed using ROIs (here: arteriole, vein, parenchyma) with a display rate of 7 Hz. The size of one single measurement pixel was 0.03 x 0.03 mm2. FINDINGS: The mean pO2 over cortex arterioles was 20.3 +/- 0.69, over veins 17.1 +/- 0.5 and over parenchyma 9.1 +/- 0.6 (mmHg +/- SD). The arterial pO2 showed a good correlation to the pO2 in the ROIs (r = 0.46-0.72, p < 0.0001, n = 198). Comparing groups with different paO2 and paCO2 we found significantly different pO2 values in the ROIs of the cortex. CONCLUSIONS: This prototype is capable of obtaining cortical pO2 maps with excellent temporal and spatial resolution and provides simultaneous imaging of the cortex structures.

Relevance of correction for rotational targeting error in functional neurosurgery.

OBJECTIVE: A prospective study is presented on the amount of targeting error that is due to rotational deviations between the atlas and the stereotactic coordinate system. MATERIALS AND METHODS: We investigated 14 volunteers with a stereotactic frame fixed to their heads by tight adhesive bands. Sagittal, coronal and axial T2-weighted MRI scans, as well as MPRage sequences, were performed. The anterior and posterior commissures and one additional point on the midline (the septum pellucidum) were determined on the axial T2-weighted images. Bilateral atlas coordinates for the subthalamic nucleus (STN), globus pallidus pars interna (GPi) and nucleus ventralis intermedius (Vim) were transformed to stereotactic frame coordinates, either without correction or by 2-point or 3-point correction. A total of 896 coordinates (x, y, z for the STN, GPi and Vim in both hemispheres) were calculated. RESULTS: Although the mean differences between the two algorithms (0.24 +/- standard deviation of 0.33 mm) were within the range of system-immanent inaccuracies in MRI-guided stereotaxy, deviations of up to 2.8 mm occurred. No significant correlation was found regarding the amount of rotational angle and the differences in x-, y-, or z-coordinates when 2-point and 3-point transformations were compared. CONCLUSIONS: The reliability of meticulous trajectory planning might be compromised significantly by using only 2-point-based correction or no calculations at all.