Optical Monitoring of Cerebral Microcirculation

Abstract

The cerebral microcirculation consists of a complex network of small blood vessels that support nerve cells with oxygen and nutrition. The blood flow and oxygen delivery in the microcirculatory blood vessels are regulated through mechanisms which may be influenced or impaired by disease or brain damage resulting from conditions such as brain tumors, traumatic brain injury or subarachnoid hemorrhage (SAH). Monitoring of parameters relating to the microvascular circulation is therefore needed in the clinical setting. Optical techniques such as diffuse reflectance spectroscopy (DRS) and laser Doppler flowmetry (LDF) are capable of estimating the oxygen saturation (SO2) and tracking the microvascular blood flow (perfusion) using a fiber optic probe. This thesis presents the work carried out to adapt DRS and LDF for monitoring cerebral microcirculation in the human brain.A method for real-time estimation of SO2 in brain tissue was developed based on the P3 approximation of diffuse light transport and quadratic polynomial fit to the measured DRS signal. A custom-made fiberoptic probe was constructed for measurements during tumor surgery and in neurointensive care. Software modules with specific user interface for LDF and DRS were programmed to process, record and present parameters such as perfusion, total backscattered light, heart rate, pulsatility index, blood fraction and SO2 from acquired signals.The systems were evaluated on skin, and experimentally by using optical phantoms with properties mimicking brain tissue. The oxygen pressure (pO2) in the phantoms was regulated to track spectroscopic changes coupled with the level of SO2. Clinical evaluation was performed during intraoperative measurements during tumor surgery (n = 10) and stereotactic deep brain stimulation implantations (n = 20). The LDF and DRS systems were also successfully assessed in the neurointensive care unit for a patient treated for SAH. The cerebral autoregulation was studied by relating the parameters from the optical systems to signals from the standard monitoring equipment in neurointensive care.In summary, the presented work takes DRS and LDF one step further toward clinical use for optical monitoring of cerebral microcirculation. SammanfattningHjärnans mikrocirkulation består av ett komplext nätverk av små blodkärl som försörjer nervceller med syre och näring. Blodflödet och syretransporten i mikrocirkulationen regleras via olika mekanismer som kan påverkas eller försämras vid sjukdom eller hjärnskada som till exempel vid hjärntumörer, traumatisk hjärnskada eller subaraknoidalblödning (SAH). Diffus reflektansspektroskopi (DRS) och laserdopplerteknik (LDF) kan användas för att uppskatta syremättnaden (SO2) och övervaka det mikrocirkulatoriska blodflödet, också kallat perfusion, med hjälp av en fiberoptisk prob. Den här avhandlingen beskriver arbetet med att anpassa DRS och LDF för att övervaka den cerebrala mikrocirkulationen.En metod för realtidsuppskattning av SO2 i hjärnvävnad utvecklades baserat på P3 approximationen av diffus...