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A Novel Method To Visualize Optimal Cerebral Blood Flow During Cranial Vault Surgery Using A 3d Imaging System
Samuel Boas, Brian Paoletti, BS, Carlyann Miller, MD, Corinne Wee, MD, Cristin Coquillard, MD, Anand Kumar, MD, Peggy Seidman, MD.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Purpose: Hyperventilation-induced hypocapnia, routinely used in the treatment of increased intracranial pressure, reduces the risk of cerebral injury during craniotomy. This study validates the use of the Vectra H1 3-Dimensional camera to measure brain volume changes at different levels of CO2 as measured by End Tidal CO2 levels (EtCO2). We hypothesized brain volumes would directly correlate with EtCO2 levels. Methods: This is case study of a single pediatric patient who underwent cranial vault remodeling. The cranial vault reconstruction proceeded as planned. Prior to replacement of the bone flap, tidal volumes were modulated to achieve EtCO2 levels of 30, 25, 35, 40, and 45 mmHg. Each EtCO2 level was stabilized for 2 minutes and the Vectra H1 camera took 3 dimensional images. Distances from fontanelle sulcus to the anterior fontanelle bony landmark, changes in brain volume in the fontanelle, and exposed fontanelle brain area were compared using Mirror 3D software. Statistical analysis was performed using SPSS version 25. Results: The distance between fontanelle sulcus to the anterior fontanelle bony landmark decreased 20% from baseline EtCO2 of 30 mmHg to 45 mmHg. There was a statistically significant, negative correlation between the distance between Fontanelle sulcus and anterior fontanelle bony landmark and EtCO2 levels (r(5)=-0.984, p=0.002). Fontanelle brain volume had a significantly positive correlation with EtCO2 levels (r(5)=0.979, p=0.021). Exposed fontanelle brain area decreased 50% from baseline EtCO2 of 30 mmHg to 45 mmHg (r(5)=-0.964, p=0.008) Conclusion: This study demonstrates the ability of a Vectra H1 camera to quantitate changes in brain volume. Three-dimensional analysis demonstrated brain volume decreased with lower EtCO2 measurements and increased with higher EtCO2 measurements which is consistent with the expected physiologic response. The Vectra H1 camera may be useful in future studies examining the intricacies of modulating brain volumes in a larger cohort of surgical patients.


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