Background: Laser Doppler flowmetry (LDF) can be used to measure cerebral microcirculation in relation to stereotactic deep brain stimulation (DBS) implantations. Objective: To investigate the microcirculation and total light intensity (TLI) corresponding to tissue grayness in DBS target regions with high-resolution LDF recordings, and to define a resolution which enables detection of small vessels. Methods: Stereotactic LDF measurements were made prior to DBS implantation with 0.5-mm steps in the vicinity to 4 deep brain targets (STN, GPi, Vim, Zi) along 20 trajectories. The Mann-Whitney U test was used to compare the microcirculation and TLI between targets, and the measurement resolution (0.5 vs. 1 mm). The numbers of high blood flow spots along the trajectories were calculated. Results: There was a significant difference (p < 0.05) in microcirculation between the targets. High blood flow spots were present at 15 out of 510 positions, 7 along Vim and GPi trajectories, respectively. There was no statistical difference between resolutions even though both local blood flow and TLI peaks could appear at 0.5-mm steps. Conclusions: LDF can be used for online tracking of critical regions presenting blood flow and TLI peaks, possibly relating to vessel structures and thin laminas along stereotactic trajectories.

Keywords:
Microcirculation, Navigation, Deep brain stimulation, Laser Doppler flowmetry, Stereotactic neurosurgery
1.
Hemm S, Wårdell K: Stereotactic implantation of deep brain stimulation electrodes: a review of technical systems, methods and emerging tools. Med Biol Eng Comput 2010;48:611-624.
2.
Johnson MD, Lim HH, Netoff TI, Connolly AT, Johnson N, Roy A, Holt A, Lim KO, Carey JR, Vitek JL, He B: Neuromodulation for brain disorders: challenges and opportunities. IEEE Trans Biomed Eng 2013;60:610-624.
3.
Hariz M, Blomstedt P, Zrinzo L: Future of brain stimulation: new targets, new indications, new technology. Mov Disord 2013;28:1784-1792.
4.
Zrinzo L, Yoshida F, Hariz MI, Thornton J, Foltynie T, Yousry TA, Limousin P: Clinical safety of brain magnetic resonance imaging with implanted deep brain stimulation hardware: large case series and review of the literature. World Neurosurg 2011;76:164-172; discussion 69-73.
5.
Gross RE, Krack P, Rodriguez-Oroz MC, Rezai AR, Benabid AL: Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson's disease and tremor. Mov Disord 2006;21(suppl 14):S259-S283.
6.
Zrinzo L, Foltynie T, Limousin P, Hariz MI: Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review. J Neurosurg 2012;116:84-94.
7.
Zrinzo L, Hariz M: Impedance recording in functional neurosurgery; in Gildenberg PL, Lozano AM, Tasker R (eds): Textbook of Stereotactic and Functional Neurosurgery. Berlin, Springer, 2009.
8.
Antonsson J, Eriksson O, Wårdell K: Radio frequency electrode system for optical lesion size estimation in functional neurosurgery. J Biomed Opt 2005;10:034020.
9.
Wårdell K, Blomstedt P, Richter J, Antonsson J, Eriksson O, Zsigmond P, Bergenheim AT, Hariz MI: Intracerebral microvascular measurements during deep brain stimulation implantation using laser Doppler perfusion monitoring. Stereotact Funct Neurosurg 2007;85:279-286.
10.
Qian Z, Sunder S, Yeqing G, Giller C, Liu H: ‘Look-ahead distance' of a fiber probe used to assist neurosurgery: Phanton and Monte Carlo study. Optics Express 2003;11:1844-1855.
11.
Johansson JD, Fredriksson I, Wårdell K, Eriksson O: Simulation of reflected light intensity changes during navigation and radio-frequency lesioning in the brain. J Biomed Opt 2009;14:044040.
12.
Johansson JD, Blomstedt P, Haj-Hosseini N, Bergenheim AT, Eriksson O, Wårdell K: Combined diffuse light reflectance and electrical impedance measurements as a navigation aid in deep brain surgery. Stereotact Funct Neurosurg 2009;87:105-113.
13.
Giller CA, Liu HL, Gurnani P, Victor S, Yasdani U, German DC: Validation of a near-infrared probe for detection of thin intracranial white matter structures. J Neurosurg 2003;98:1299-1306.
14.
Antonsson J, Eriksson O, Blomstedt P, Bergenheim AT, Hariz IM, Richter J, Zsigmond P, Wårdell K: Diffuse reflectance spectroscopy measurements for tissue-type discrimination during deep brain stimulation. J Neural Eng 2008;5:185-190.
15.
Giller CA, Liu H, German DC, Kashyap D, Dewey RB: A stereotactic near-infrared probe for localization during functional neurosurgical procedures: further experience. J Neurosurg 2009;110:263-273.
16.
Johansson JD, Wårdell K: Intracerebral quantitative chromophore estimation from reflectance spectra captured during deep brain stimulation implantation. J Biophotonics 2013;6:435-445.
17.
Wårdell K, Zsigmond P, Richter J, Hemm S: Relationship between laser Doppler signals and anatomy during deep brain stimulation electrode implantation toward the ventral intermediate nucleus and subthalamic nucleus. Neurosurgery 2013;72(suppl operative):127-140.
18.
Nilsson GE, Tenland T, Öberg PA: Evaluation of a laser Doppler flowmeter for measurement of tissue blood flow. IEEE Trans Biomed Eng 1980;27:597-604.
19.
Strömberg T, Wårdell K, Larsson M, Salerud S: Laser Doppler monitoring and imaging techniques; in Vo-Dinh T (ed): Biomedical Photonics Handbook. Boca Raton, CRC Press, 2014, pp 435-459.
20.
Jacobs P: Sterrad 100S, sterilisation system. Johnson & Johnson, 2006.
21.
Terao T, Takahashi H, Yokochi F, Taniguchi M, Okiyama R, Hamada I: Hemorrhagic complication of stereotactic surgery in patients with movement disorders. J Neurosurg 2003;98:1241-1246.
22.
Ben-Haim S, Asaad WF, Gale JT, Eskandar EN: Risk factors for hemorrhage during microelectrode-guided deep brain stimulation and the introduction of an improved microelectrode design. Neurosurgery 2009;64:754-762; discussion 762-763.
23.
Lemaire JJ, Sakka L, Ouchchane L, Caire F, Gabrillargues J, Bonny JM: Anatomy of the human thalamus based on spontaneous contrast and microscopic voxels in high-field magnetic resonance imaging. Neurosurgery 2010;66(suppl operative):161-172.
24.
Hillman EM: Optical brain imaging in vivo: techniques and applications from animal to man. J Biomed Opt 2007;12:051402.
25.
Warden MR, Cardin JA, Deisseroth K: Optical neural interfaces. Annu Rev Biomed Eng 2014;16:103-129.
26.
Wårdell K, Jakobsson A, Nilsson GE: Laser Doppler perfusion imaging by dynamic light scattering. IEEE Trans Biomed Eng 1993;40:309-316.
27.
Raabe A, Van De Ville D, Leutenegger M, Szelenyi A, Hattingen E, Gerlach R, Seifert V, Hauger C, Lopez A, Leitgeb R, Unser M, Martin-Williams EJ, Lasser T: Laser Doppler imaging for intraoperative human brain mapping. Neuroimage 2009;44:1284-1289.
28.
Dreier JP, Major S, Manning A, Woitzik J, Drenckhahn C, Steinbrink J, Tolias C, Oliveira-Ferreira AI, Fabricius M, Hartings JA, Vajkoczy P, Lauritzen M, Dirnagl U, Bohner G, Strong AJ: Cortical spreading ischaemia is a novel process involved in ischaemic damage in patients with aneurysmal subarachnoid haemorrhage. Brain 2009;132:1866-1881.
29.
Rejmstad P, Åkesson G, Åneman O, Wårdell K: A laser Doppler system for monitoring cerebral microcirculation: implementation and evaluation during neurosurgery. Med Biol Eng Comput 2015, Epub ahead of print.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.