AVM手术是具有挑战性的,这是由于在其切除期间进行性且通常不可预见的流量变化,其涉及AVM和周围的脑组织。因此,准确监测血流对减少并发症和改善预后至关重要.以下病例报告说明了可以提供实时血流评估的免费非侵入性工具的有用性。我们介绍了一个案例,演示了激光散斑对比成像(LSCI)在评估AVM手术期间血管流动动力学中的应用。一名30岁的女性突然出现头痛,恶心,呕吐,和眩晕.紧急成像显示小脑AVM破裂,需要手术干预。LSCI被整合到手术工作流程中,提供AVM周围血管的相对脑血流量(rCBF)的连续可视化。AVM切除前,LSCI测量显示动脉化脉管系统供应AVMnidus;AVM切除后的测量显示出显着的血液动力学变化,包括最初动脉化的AVM引流静脉和相邻动脉分支的正常流量。LSCI还检测到临时闭塞期间的血流变化,能够评估下游血管区域。总之,我们提供了一个支持LSCI用于AVM切除手术期间实时血流动力学监测的示例.LSCI提供非侵入性,连续,和即时的血流信息,补充传统的成像方法,如吲哚菁绿血管造影。此外,我们的研究结果表明,LSCI有可能提供一种非侵入性方法来识别从特定血管接受血液供应的特定浅表血管分支或皮质区域.
AVM surgery is challenging due to progressive and often unforeseeable flow changes during its resection which involve both the AVM and the surrounding brain tissue. Hence, accurate monitoring of blood flow is crucial to minimize complications and improve outcomes. The following
case report illustrates the usefulness of complimentary non-invasive tools that can provide real time blood flow assessment. We present a
case demonstrating the application of laser speckle contrast imaging (LSCI) in evaluating vessel flow dynamics during AVM surgery. A 30-year-old female presented with sudden headaches, nausea, vomiting, and vertigo. Emergency imaging revealed a ruptured cerebellar AVM necessitating surgical intervention. LSCI was integrated into the surgical workflow, providing continuous visualization of relative cerebral blood flow (rCBF) of vessels surrounding the AVM. Before AVM resection, LSCI measurements revealed the arterialized vasculature supplying the AVM nidus; measurements after AVM resection showed significant hemodynamic changes including normal flow in the initially arterialized AVM draining veins and adjacent arterial branches. LSCI also detected blood flow alterations during temporary occlusion, enabling assessment of downstream vascular regions. In conclusion, we provide an example supporting the utility of LSCI for real-time hemodynamic monitoring during AVM resection surgery. LSCI offers non-invasive, continuous, and immediate blood flow information, complementing conventional imaging methods like indocyanine green angiography. Additionally, our findings suggest that LSCI has the potential to provide a non-invasive means of identifying the specific superficial vessel branches or cortical areas that receive blood supply from a particular vessel.