Johan Antonsson

Intracerebral microvascular measurements during deep brain stimulation implantation using laser Doppler perfusion monitoring.

The aim of the study was to investigate if laser Doppler perfusion monitoring (LDPM) can be used in order to differentiate between gray and white matter and to what extent microvascular perfusion can be recorded in the deep brain structures during stereotactic neurosurgery. An optical probe constructed to fit in the Leksell® Stereotactic System was used for measurements along the trajectory and in the targets (globus pallidus internus, subthalamic nucleus, zona incerta, thalamus) during the implantation of deep brain stimulation leads (n = 22). The total backscattered light intensity (TLI) reflecting the grayness of the tissue, and the microvascular perfusion were captured at 128 sites. Heartbeat-synchronized pulsations were found at all perfusion recordings. In 6 sites the perfusion was more than 6 times higher than the closest neighbor indicating a possible small vessel structure. TLI was significantly higher (p < 0.005) and the perfusion significantly lower (p < 0.005) in positions identified as white matter in the respective MRI batch. The measurements imply that LDPM has the potential to be used as an intracerebral guidance tool.

Diffuse reflectance spectroscopy measurements for tissue-type discrimination during deep brain stimulation.

Diffuse reflectance spectroscopy as a method for improving intracerebral guidance during functional neurosurgery has been investigated. An optical probe was developed for measurements during stereotactic and functional neurosurgery in man. The aim of the study was to investigate the spectral differences between white and grey matter and between white matter and functional targets. Diffuse reflectance spectroscopy measurements in ten patients were recorded at incremental steps towards and in three different functional targets (STN, GPi and Zi). The recorded spectra along the trajectory were sorted into white or grey matter, based on preoperative MRI images or the recorded spectral shape and intensity. The difference between tissue types was calculated as a quotient. Significant intensity differences between white and grey matter were found to be at least 14% (p < 0.05) and 20% (p < 0.0001) for MRI and spectral-sorted data respectively. The reflectance difference between white matter and the functional targets of GPi was higher than for STN and Zi. The results indicate that diffuse reflectance spectroscopy has a potential to be developed to a suitable complement to other intracerebral guidance methods.

Optical Measurements during Experimental Stereotactic Radiofrequency Lesioning

The aim of this study was to evaluate in vivo a laser Doppler measurement system in porcine brain tissue during thermal lesioning. A 2-mm monopolar radiofrequency lesioning electrode was equipped with optical fibers in order to monitor the lesioning procedure. Laser Doppler and backscattered light intensity signals were measured along the electrode trajectory and during bilateral lesioning in the central gray (70, 80 and 90°C, n = 14). The time course of the coagulation process could be followed by optical recordings. Two separate groups of tissue were identified from the intensity signals. The changes in the perfusion levels in both groups displayed significant changes (p < 0.05, n = 48) at all temperature settings, while backscattered light intensity was significant for only one group at the different temperatures (p < 0.05, n = 39). These results indicate that optical measurements correlate with lesion development in vivo. The study also indicates that it is possible to follow the lesioning process intra-operatively.

In vitro measurements of optical properties of porcine brain using a novel compact device

Knowledge of the optical properties of tissues can be applied in numerous medical and scientific fields, including cancer diagnostics and therapy. There are many different ways of determining the optical properties of turbid media. The paper describes measurements of the optical properties of porcine brain tissue using novel instrumentation for simultaneous absorption and scattering characterisation of small turbid samples. Integrating sphere measurements are widely used as a reference method for determination of the optical properties of relatively thin turbid samples. However, this technique is associated with bulky equipment, complicated measuring techniques, interference compensation techniques and inconvenient sample handling. It is believed that the sphere for some applications can be replaced by a new, compact device, called the combined angular and spatially resolved head sensor, to measure the optical properties of thin turbid samples. The results compare very well with data obtained with an integrating sphere for well-defined samples. The instrument was shown to be accurate to within 12% for μa and 1% for μs′ in measurements of intralipid-ink samples. The corresponding variations of data were 17% and 2%, respectively. The reduced scattering coefficient for porcine white matter was measured to be 100 cm−1 at 633 nm, and the value for coagulated brain tissue was 65 cm−1. The corresponding absorption coefficients were 2 and 3 cm−1, respectively.

In vivo reflection spectroscopy measurements in pig brain during stereotactic surgery

Radio frequency (RF) lesioning in the human brain is a common surgical therapy for relieving severe pain as well as for movement disorders such as Parkinsonia. During the procedure a small electrode is introduced by stereotactic means towards a target area localized by CT or MRI. An RF-current is applied through the electrode tip when positioned in the target area. The tissue in the proximity of the tip is heated by the current and finally coagulated. The overall aim of this study was to improve the RF-technique and its ability to estimate lesion size by means of optical methods. Therefore, the optical differences between white and gray matter, as well as lesioned and unlesioned tissue were investigated. Reflection spectroscopy measurements in the range of 450-800 nm were conducted on fully anesthetized pigs during stereotactic RF-lesioning (n=6). Light from a tungsten lamp was guided to the electrode tip through optical fibers, inserted along a 2 mm in diameter monopolar RF-electrode. Measurements were performed in steps of 0-10 mm from the target in each hemisphere towards the entry point of the skull. In the central gray of the porcine brain measurements were performed both before and after the creation of a lesion. A total of 55 spectra were collected during this study. Correlation to tissue type was done using post-operative MR-images. The spectral signature for white and gray matter differs significantly for the entire spectral range of 450-800 nm. Pre- and post-lesioning reflection spectroscopy showed the largest differences below 600 and above 620 nm, which implies that lasers within this wavelength range may be useful for in-vivo measurements of tissue optical changes during RF-lesioning.

Radio frequency electrode system for optical lesion size estimation in functional neurosurgery

Radiofrequency (RF) lesioning in the human brain is one possible surgical therapy for severe pain as well as movement disorders. One obstacle for a safer lesioning procedure is the lack of size monitoring. The aim of this study was to investigate if changes in laser Doppler or intensity signals could be used as markers for size estimation during experimental RF lesioning. A 2 mm in diameter monopolar RF electrode was equipped with optical fibers and connected to a digital laser Doppler system. The optical RF electrodes performance was equal to a standard RF electrode with the same dimensions. An albumin solution with scatterers was used to evaluate the intensity and laser Doppler signal changes during lesioning at 70, 80, and 90 degrees C. Significant signal changes were found for these three different clot sizes, represented by the temperatures (p<0.05, n=10). The volume, width, and length of the created coagulations were correlated to the intensity signal changes (r=0.88, n=30, p<0.0001) and to the perfusion signal changes (r=0.81, n=30, p<0.0001). Both static and Doppler-shifted light can be used to follow the lesioning procedure as well as being used for lesion size estimation during experimental RF lesioning.

A laser Doppler system for intracerebral measurements during stereotactic neurosurgery

A laser Doppler system for intracerebral measurements during stereotactic and functional neurosurgery is presented. The system comprises a laser Doppler perfusion monitor, an optical probe adapted for the Leksellreg stereotactic system and a personal computer with software for acquisition, data analysis and presentation. The software makes it possible to present both the perfusion and the total backscattered light intensity (TLI) in real-time. During intracerebral measurements, the perfusion signal records the tissues microcirculation whereas the TLI signal may be used to distinguish between grey and white matter. Evaluation of the system has been done during stereotactic neurosurgery in relation to implantation of deep brain stimulation electrodes. Measurements were made along trajectories towards targets in the deep brain structure as well as in pre-calculated target areas. The measurements show that the system has a potential to be used for intracerebral guidance but further evaluation of the technique is needed.