Intraoperative Messung der zerebralen Mikrozirkulation mittels Laser Doppler Scanning Imager

Intra-cranial neurosurgical operations without the use of retractors of the brain are hardly imaginable. Contusions and infarctions of the brain are strongly related with this technique. In this study we evaluated the influence of two different retractors of the brain (metall- and silicon-retractors) on the cerebral microperfusion and traumatisation of the brain-tissue in a chinchilla-rabbit-model comparing LDSI (Laser-Doppler-Scanning-Imager)-measurements with histopathological analysis and MRI-images. Additionally the cerebro-protective effect of Mannitol, Nimodipine, Dexamethasone, Dopamine and Urapidil was examined during the application of the retractors as well as their influence on the rCBF (regional cerebral blood flow). The performed LDSI-measurements showed a reduction of perfusion of the brain tissue after application of pressure with the retractor. After the elimination of the pressure we were able to proof a reactive hyperaemia in all tests. Using LDSI-measurements the comparison of the two different types of retractors showed a significantly less pronounced reduction of the rCBF regarding the silicon-retractor. These findings were confirmed by histopathological analysis. The measurements of perfusion after application of the examined cerebro-protective substances showed best effects with Dopamine, Nimodipine and Mannitol. Dopamine was the most potent drug regarding the bloodflow. The Dexamethasone-group in this study did not show a positive influence on the histological presentation of post-ischaemic oedema. The originally planned comparison between the measurements of perfusion with the histopathological results and MRI-examinations coul technically not be realised. The LDSI-examination proofed to be a very good method for the assessment of regional perfusion. It is a usefull clinical tool for early identification of critical hypoperfusion. Summarized the use of a silicon-retractor in combination with Nimodipine or Mannitol is a usefull concept to lower damage to the brain-tissue after application of pressure with a retractor. Further and especially clinical observations are necessary to evaluate potential therapies with combinations of several neuro-protective drugs.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2005

Author dc:creator

• Hartmann, Michael

Contributors dc:contributor

• Gilsbach, Joachim M.

• info:eu-repo/classification/ddc/610
• Medizin

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-121867%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:60142