Intraoperative Imaging of Cortical Blood Flow by Camera-Based Photoplethysmography at Green Light

Intraoperative evaluation of blood perfusion in the brain cortex is an important but hitherto unresolved problem. Our aim was to demonstrate the feasibility of cerebral microcirculation assessment during open brain surgery by using camera-based photoplethysmography (cbPPG) synchronized with an electrocardiograph. Cortical blood flow was monitored in five patients with different diagnoses. Two cases (tumor resection and extra-intracranial bypass grafting) are presented in detail. Blood-flow parameters were visualized after processing cortex images recorded under green-light illumination before and after surgical intervention. In all cases, blood flow was successfully visualized in >95% of open brain. Distributions of blood pulsation amplitude, a parameter related to cortical blood perfusion; pulse arrival time; and blood-pressure-pulse shape were calculated with high spatial resolution (in every pixel). Changes in cerebral blood supply caused by surgical intervention were clearly revealed. We have shown that the temporal spread of pulse arrival time and the spatiotemporal variability of pulse shape are very sensitive markers of brain circulatory disturbances. The green-light cbPPG system offers a new approach to objective assessment of blood-flow changes in the brain during surgical intervention. The proposed system allows for contactless monitoring of cortex blood flow in real time with high resolution, thus providing useful information for surgery optimization and minimization of brain tissue damage.