Somanetics INVOS 3100 cerebral oximeter.
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Cerebrovascular Circulation↗
Biomedical subjects
M Dujovny
Publications and source records attributed to M Dujovny.
Microvascular anatomy of the anterior surface of the medulla oblongata and olive.
The arterial supply and the microanatomy of the anterior surface of the medulla oblongata and olive were studied in 11 cadaveric specimens, with investigation of the size, course, and length of the arteries. Two distinct anatomical entities divide the vascular supply in this region: 1) the pyramid, which is the anterior surface of the medulla; and 2) the olive, which is adjacent to the lateral aspect of the pyramid. Primary vascularization of the pyramid was via small branches of the anterior spinal artery, a branch of the vertebral artery. Minute perforators from the anterior spinal artery were found in all specimens. Arterial supply to the olive varied by location: its anterior aspect was primarily supplied by the anterior spinal artery; the upper portion of the posterior aspect of the olive was supplied by the vertebral artery, the anterior inferior cerebellar artery, and the basilar artery; and the middle and lower portions of the posterior aspect were fed by the vertebral artery and posterior inferior cerebellar artery. These arteries supplied the medulla through the small branches directed toward the olive. The authors observed a wide anastomotic net connecting the small arteries in this area. These patterns of microvascular supply of the pyramid and olive may deepen the understanding of clinical and pathological conditions resulting from arterial occlusion. The existence of an anastomotic net may account for the rare incidence of medullary infarction in the olive region.
Basilar Artery↗
Use of transcranial cerebral oximetry to monitor regional cerebral oxygen saturation during neuroendovascular procedures.
Using transcranial cerebral oximetry, we monitored 30 patients who underwent cerebral angiography by the femoral route. Transcranial cerebral oximetry is a noninvasive technique of regional cerebral oxygen saturation measurement that uses near-infrared spectroscopy to differentiate oxyhemoglobin from reduced hemoglobin. Needle puncture, catheterization, and contrast media injection produced no significant peak changes in saturation from baseline. Acute and persistent decreases in oxygen saturation were associated with vascular complications and were detected before development of clinical symptoms. Greater changes in saturation were observed during several neuroendovascular procedures, indicating the development of complications, signaling a need to stop further endovascular manipulation.
Brain↗
Microsurgical anatomy of the posterior choroidal arteries.
In this study, we analysed the microanatomy of the medial and lateral posterior choroidal arteries, which supply vital central nervous system structures to the brainstem and choroids plexus. We traced the anatomical course of the medial and lateral posterior choroid arteries, their origin, diameter, number of branches, length, and anatomical variations. Twenty-six human unfixed brains were injected through the vertebral and carotid arteries with silicon rubber. Fifty-one out of a total of 129 vessels were medial posterior, and 78 were lateral posterior choroidal arteries. We divided the medial posterior choroidal artery into three segments: around the brainstem, quadrigeminal-pineal, and choroidal. The mean length of the medial posterior choroidal artery was 77.6 +/- 15 mm on the right side, and 77.1 +/- 15 mm on the left; the mean outer diameter observed was 0.8 +/- 0.5 mm on the right side, and 0.8 +/- 0.4 mm on the left. The number of branches arising from the medial posterior choroidal arteries averaged 25 +/- 9. In the lateral posterior group, the mean length observed was 49.5 +/- 26 mm on the right, and 58.0 +/- 23 mm on the left. There were instances of duplication and triplication of the lateral posterior choroidal vessels. The outer diameter averaged 0.72 mm on the right, and 0.6 mm on the left. The posterior choroidal arteries are clearly an important vascular component. A comprehensive knowledge of their anatomy will aid the neurosurgeon during surgery of the brainstem, pineal region, and third ventricle, and will limit complications resulting from injury to these arteries.
Arteries↗
Early hemodynamic changes at the microcirculatory level and effects of mannitol following focal cryogenic injury.
Changes in cerebral blood flow due to infusion of hyperosmolar solutions are of considerable importance in states of raised intracranial pressure. The present study was aimed to evaluate the effects of mannitol on the cerebral microcirculation, in a model of vasogenic brain edema. A right fronto-parietal craniotomy was performed in 30 adult Sprague-Dawley rats. Vasogenic edema was produced by placing dry-ice over the dura for 1 min. The cortical blood flow was monitored for 120 min using a laser-Doppler flowmeter (Perimed, Stockholm, Sweden), and graphics were recorded using a personal computer. Animals were randomly divided into three groups: group 1 (control group) received no mannitol; group 2 was treated with a bolus injection of 20% mannitol (1 mg kg-1); group 3 received the same dose over a 30 min infusion. Mean blood pressure, temperature, and respiratory rate were continuously monitored. At the end of the procedure, an intravenous injection of Evan's blue 2% was given. Results were compared by using repeated measures of analysis of variance and a two-sample t-test at each time. After the production of a cryogenic injury, we found a marked decrease in the cerebral blood flow, whereas mannitol partially reversed that effect. There was not significant difference between groups 2 and 3; however, there was a significant difference between mannitol and control groups after 15 min. During the early phase of vasogenic edema, early use of mannitol did not increase the blood flow, but stabilized it, preventing further decrease. Laser-Doppler flowmetry is a valuable method for continuous estimation of hemodynamic changes in the cerebral microcirculation.
Analysis of Variance↗
Clinical experience with transcranial cerebral oximetry.
Transcranial cerebral oximetry based on the principle of near-infrared spectroscopy has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. The non-invasive technique of cerebral oximetry provides valuable information about brain oxygenation in patients with cerebral ischemia (due to occlusion or stenosis of the internal carotid artery). It is also used in intraoperative monitoring of carotid endarterectomy and surgical procedures performed under deep hypothermia and circulatory arrest, during neuroendovascular procedures, and in critical care settings (in patients with arterial vasospasm and during the terminal period). This article describes our preliminary clinical experience with the use of this new technique and summarizes the current literature on clinical and experimental use of transcranial cerebral oximetry.
Algorithms↗
Use of cerebral oximetry to monitor brain oxygenation reserves for skull base surgery.
We used cerebral oximetry based on near-infrared re-emittance spectroscopy for noninvasive evaluation of the cerebral regional oxygen saturation (rSO(2)) to preoperatively assess patients with skull base tumors and giant arterial aneurysms, for whom possible occlusion or partial resection of the internal carotid artery was considered. Monitoring cerebral oxygen saturation was performed during both endovascular (balloon) and open surgical test occlusions of the internal carotid artery. The presence (or absence) of changes in the cerebral oxygen saturation served as a criterion of the patient's tolerance to permanent occlusion of the internal carotid artery. In all cases the curves of saturation accurately corresponded to the clinical condition of the patients, primarily to the developing of neurological signs. Cerebral oximetry was an extremely informative and reliable technique for fast, easy, and noninvasive detection of changes in brain blood circulation. Generally, cerebral oximetry serves as a valuable adjunct in detection of brain tolerance to the occlusion of major arterial vessels and in monitoring the condition of the brain in regard to its oxygenation and perfusion.
Journal Article↗
Optic canal: microanatomic study.
The microsurgical anatomy of the optic canal was defined on 20 cadaveric specimens. Anatomic parameters of the optic canal, optic nerve, ophthalmic artery, and adjacent structures were measured, and relations of these structures were noted. Five variants of the course of the ophthalmic artery relative to the optic nerve in the optic canal were found. Various aspects of microsurgery of the optic canal are discussed in relation to anatomic findings.
Journal Article↗
Aneurysm clips: twenty years later.
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Aneurysm↗
Monitoring the intracranial aneurysm patient.
The perioperative management of aneurysmal subarachnoidal haemorrhage is challenging and often requires an extensive team work. Unfortunately, there is no uniform system applied for perioperative monitoring of patients with subarachnoid haemorrhage. The new developing technology enhances our monitoring capability with subsequent impact on patient's outcome. This article presents a review of current monitoring modalities applicable to patients with subarachnoid haemorrhage with emphasis on the central nervous system and some of the authors' experience.
Humans↗
Pineal region: rare location of a cavernous haemangioma.
Cavernous haemangiomas are commonly located within the central nervous system. There are only 11 cases of this malformation found in the pineal region reported in the literature, and only four of them have documenting photomicrographs. Very little has been written about diagnostic features of these tumours when they occur in this area. We describe our diagnosis of a cavernous haemangioma in the pineal region with special emphasis on its radiologic and histologic aspects.
Adult↗
Microsurgical anatomy of the intracranial part of the vertebral artery.
We studied the intracranial portion of the vertebral artery and its branches in 11 cadaveric specimens. We evaluated the course of vessels and their dimensions (external diameter and length), as well as relationships between each of them. The vertebral artery was larger on the left side in two cases, on the right in five cases, and equal on both sides in four cases. The right and left vertebral arteries joined each other forming the basilar artery at the level of the pontomedullary junction in four cases, 2 mm below it in one case, and 1 to 7 mm above it in six cases. We divided all branches of the intracranial vertebral artery into two groups: the medial branches and the lateral branches. Two major types of medial branches were observed: the anterior spinal artery and the branches of the foramen caecum. The origin of the anterior spinal artery was located 6.5 mm (5-11 mm) proximal to vertebrobasilar junction on the right and 8.5 mm (6-17 mm) on the left. The anterior spinal artery was absent on the right in two cases and on the left in one. Branches arising from the vertebral artery to the foramen caecum were found in four brains. Lateral branches originated from the posterolateral or lateral aspect of vertebral artery. The posterior inferior cerebellar artery, the largest branch of the vertebral artery, was included in this group. Other branches were mostly located between the origin of the posterior inferior cerebellar artery and the vertebrobasilar junction. Forty-six lateral branches originating from the vertebral artery were found in 11 brains (26 on the right and 20 on the left). Lateral branches widely anastomosed with perforators from the basilar artery, posterior inferior cerebral artery, and the anterior inferior cerebellar artery.
Arteriovenous Anastomosis↗
Microsurgical anatomy of the trigeminal nerve.
We studied the trigeminal nerve in the middle cranial fossa in 20 cadaveric specimens (10 fixed skull base). Specifically, we analysed the relationships among the gasserion or trigeminal ganglion (herein referred to as the gasserion ganglion), the internal carotid artery, and the petrous bone. The dimensions of the trigeminal ganglia, the length from the ganglia to the exit foramina, and the width of the ophthalmic, maxillary, and manidibular nerves were also studied. The foramina of the middle cranial fossa were measured for their diameter and their distance from each other. Our paper compares our study to previous studies and the measurements taken in those studies. The lesions affecting the ganglion and the nerves are discussed and the surgical approaches to the middle cranial fossa, the petrous bone, and the upper clivus are also reviewed.
Adult↗
Microsurgical anatomy of the supratentorial arachnoidal trabecular membranes and cisterns.
We examined the microsurgical anatomy of the supratentorial subarachnoid cisterns with a surgical microscope in 20 brains prepared using the immersion technique. The adult brains were immersed in Ringer's solution and air was injected into the subarachnoid cisterns while the brains remained submerged in solution. We identified nine trabecular membranes that limit the 15 cisterns. We specifically looked at the anatomical relationship between the supratentorial trabecular membranes and cisterns to their corresponding vessels and cranial nerves. The cistern divisions and the dispositions of trabecular membranes were closely related to the vascular division patterns of the principal brain arteries. A clear and thorough understanding of the neuroanatomical structures of the subarachnoid cisterns is important because they provide natural pathways to neurovascular and cranial nerve structures. These pathways allow access to intracranial arteries, veins, and nerves during microvascular procedures without disturbing surrounding important brain structures.
Adolescent↗
Language-activated single-photon emission tomography imaging in the evaluation of language lateralization--evidence from a case of crossed aphasia: case report.
We report a right-handed patient who developed a nonfluent aphasia after surgery for a right parietal arteriovenous malformation. Resting brain single-photon emission tomography displayed decreased regional cerebral blood flow only in the right hemisphere, with spared regional cerebral blood flow in the left hemisphere. Single-photon emission tomography performed after a language activation task (Boston Naming Task) showed a consistent area of increased regional cerebral blood flow in the right inferior and posterior frontal lobe, supporting a right hemisphere dominance for language. These results suggest a potential role for this noninvasive study in the evaluation of language lateralization.
Adult↗
Management of the internal carotid artery (ICA) when it must be occluded during skull base tumor or aneurysm surgery.
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Carotid Artery, Internal↗
Determination of regional cerebral oxygen consumption in the human: 17O natural abundance cerebral magnetic resonance imaging and spectroscopy in a whole body system.
17O natural abundance imaging in a whole body imager is demonstrated using standard MRI spectrometer and 1H imaging methods. A novel design of a highly sensitive 17O/1H doubly tuned surface head coil is shown. The head probe allows simultaneous acquisition of 17O and 1H images using a single coil. The relatively low 17O signal intensity due to the low natural abundance of 17O (0.037 atom percent) is partially compensated by fast repetition of the pulse sequence, achievable due to the short spin lattice relaxation time, T1. A small number of signal averages (e.g., NEX = 50) is sufficient for obtaining images having signal to noise of about 5:1. Due to the short longitudinal relaxation time of 17O, i.e., 2-5 msec, short TR values can be used. 128 phase encoding steps with TR = 10-25 msec correspond to total acquisition time of 1 to 2.5 min. Due to the small gyromagnetic ratio of 17O and the relatively small gradients in a standard whole body system, i.e. 0.5 G/cm, the image in-plane resolution is about 3 mm and a slice thickness of 15 mm. In vivo 17O MRS and MRI natural abundance spectroscopic signals and images of human brain have been observed. The transverse relaxation time, T2 was found to be 2.00 +/- 0.17 msec at 1.5 T. MRS 17O measurements of signal intensity in the occipital cortex during inhalation of oxygen gas, 21.8% 17O enriched, showed a maximum signal enhancement of 25% within the inhalation period. The rate of the metabolism of oxygen (CMRO2) in the occipital cortex was found to be 1.5 mumole/(g tissue) in good agreement with the value of 1.435 mumole/(g tissue) given in the literature. Current measurements using higher 17O enrichments and larger quantities of 17O enriched oxygen gas will enhance resolution and provide more accurate determination of the rate of oxygen metabolism rate and blood flow. The potential of 17O imaging is thus demonstrated in physiological in vivo studies of cerebral metabolism of oxygen and blood flow.
Brain↗
A quantitative investigation of the variability of the major cerebral arterial territories.
BACKGROUND AND PURPOSE: We have previously reported that the topographic variability of the territories of the anterior, middle, and posterior cerebral arteries is much larger than is generally considered in the literature. In the current study, we quantitatively investigated the variability of the territorial distribution of the major cerebral arteries and analyzed its relation to the variability of the circle of Willis. METHODS: In 23 human brains, the volumes of the major cerebral territories were calculated and the diameters of the contributing arteries were measured and standardized for size. RESULTS: The variability of the standardized territorial volumes proved to be considerably large and strongly correlated with the variability of the diameters of the arteries emanating from the circle of Willis. Furthermore, the relative vascular densities in the gray and white matter were determined. Taking these densities into account, an estimation of the relative peripheral resistance of the contributing arteries was made. CONCLUSIONS: We hypothesize that the morphological variability of the cerebral vascular system is related to the peripheral resistance of the major cerebral arteries and, consequently, to flow patterns, both of which are hemodynamic factors. We suggest that hemodynamic factors predominantly determine the form and size of the cerebral vascular system.
Brain↗