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Peter J. Kirkpatrick, Pietr Smielewski, Peter C. Whitfield, Marik Czosnyka, David Menon and John D. Pickard

below baseline values. Thus, in these individuals, tHb increased during this period. Fig. 2. Graphic displays of near-infrared spectroscopy showing changes in signals during carotid endarterectomy. A: Case 6, in which gradual recovery of the HbO 2 and Hb content followed ICA cross-clamping, and was complete by the time of clamp release. No hyperemic response was seen. B: Case 8 underwent an intraoperative shunt; application of the ICA cross-clamp caused a greater than 50% fall in FV and a sustained depression of the CFM signal. A Javid shunt was positioned

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Peter J. Kirkpatrick, Piotr Smielewski, Marek Czosnyka, David K. Menon and John D. Pickard

-injured patients. We have incorporated near-infrared spectroscopy (NIRS) as a potential means of registering events of cerebral desaturation noninvasively with high temporal resolution. Controversy remains over which tissue (brain or scalp) is primarily responsible for light attenuation in adult NIRS, what spatial resolution is provided, and the various algorithms used for quantification purposes. 10, 29 Despite these reservations, we have been encouraged by the signal changes recorded during carotid endarterectomy, which show plausible changes in chromophore levels of

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Mateo Calderon-Arnulphi, Ali Alaraj, Sepideh Amin-Hanjani, William W. Mantulin, Chiara M. Polzonetti, Enrico Gratton and Fady T. Charbel

, Dinkel M : Comparison of near-infrared spectroscopy and somatosensory evoked potentials for the detection of cerebral ischemia during carotid endarterectomy . Stroke 29 : 2032 – 2037 , 1998 3 Buchthal A , Belopavlovic M , Mooij JJ : Evoked potential monitoring and temporary clipping in cerebral aneurysm surgery . Acta Neurochir (Wien) 93 : 28 – 36 , 1988 4 Cheng MA , Theard MA , Tempelhoff R : Anesthesia for carotid endarterectomy: a survey . J Neurosurg Anesthesiol 9 : 211 – 216 , 1997 5 Choi J , Wolf M , Toronov V

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Yoshihiro Murata, Yoichi Katayama, Kaoru Sakatani, Chikashi Fukaya and Tsuneo Kano

varying degrees of hemodynamic compromise. For similar reasons, little is yet known regarding the temporal changes in bypass function after surgery, although such information appears to be critically important when selecting cases appropriate for studies in which the clinical effects of EC—IC bypass surgery in preventing stroke are examined. Near-infrared spectroscopy is a noninvasive optical technique used to measure concentration changes in HbO 2 and deoxyhemoglobin in cerebral vessels based on the characteristic absorption spectra of hemoglobin in the near

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Peter J. Kirkpatrick, Joseph Lam, Pippa Al-Rawi, Piotr Smielewski and Marek Czosnyka

time of flight measurement. Phys Med Biol 33 : 1433 – 1442 , 1988 Delpy DT, Cope M, van der Zee P, et al: Estimation of optical pathlength through tissues by direct time of flight measurement. Phys Med Biol 33: 1433–1442, 1988 5. Duncan A , Meek JH , Clemence M , et al : Measurement of cranial optical path length as a function of age using phase resolved near infrared spectroscopy. Pediatr Res 39 : 889 – 894 , 1996 Duncan A, Meek JH, Clemence M, et al: Measurement of cranial optical path length as a

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Shankar P. Gopinath, Claudia S. Robertson, Charles F. Contant, Raj K. Narayan, Robert G. Grossman and Britton Chance

onset of clinical neurological deterioration. A CT scan could then be performed to obtain more information about the size and location of the hematoma. A previous study demonstrated that near-infrared spectroscopy (NIRS) performed in the emergency room reliably identified the presence of a traumatic intracranial hematoma in each of 40 patients in whom a CT scan also revealed the presence of a hematoma. 13 The majority of the hematomas detected were subdural (22) or epidural (10). Only eight patients had intracerebral hematomas. The difference in absorbance of near

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Philipp Taussky, Brandon O'Neal, Wilson P. Daugherty, Sothear Luke, Dallas Thorpe, Robert A. Pooley, Clay Evans, Ricardo A. Hanel and William D. Freeman

without direct measurement of CBF. Near-infrared spectroscopy offers the advantage of measuring brain tissue arteriovenous oxygenation via an emitted near-infrared light that penetrates the scalp and underlying brain tissue and detects the absorption of oxygenated hemoglobin compared with deoxygenated hemoglobin. As a result, NIRS provides a noninvasive, real-time, bedside monitoring tool of cerebral oximetry in critically ill brain-injured patients without exposing patients to radiation. The correlation of CBF as measured by NIRS and CT perfusion has not been studied

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Neurosurgical Forum: Letters to the Editor To The Editor Mukesh Misra , M.D. , M. S. Alp , M.D. , Manuel Dujovny , M.D. , James I. Ausman , M.D. Neuropsychiatric Institute Chicago, Illinois 363 364 We greatly enjoyed reading the thought-provoking article by Kirkpatrick, et al. We would like to congratulate the authors for an excellent study evaluating the use of near-infrared spectroscopy (NIRS) in patients with head injury (Kirkpatrick PJ, Smielewski P

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Neurosurgical Forum: Letters to the editor To The Editor T. J. Germon , F.R.C.S. , A. E. R. Young , F.R.C.A. , R. J. Nelson , F.R.C.S. Frenchay Healthcare Trust, Bristol, England 1111 1112 We read with interest the paper by Kirkpatrick and colleagues (Kirkpatrick PJ, Smielewski P, Whitfield PC, et al: An observational study of near-infrared spectroscopy during carotid endarterectomy. J Neurosurg 82: 756–763, May, 1995) in which they studied cerebral near-infrared

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Neurosurgical Forum: Letters to the editor To The Editor Julio Cruz , M.D. University of Pennsylvania Philadelphia, Pennsylvania 181 182 At the end of their study (Gopinath SP, Robertson CS, Grossman RG, et al: Near-infrared spectroscopic localization of intracranial hematomas. J Neurosurg 79: 43–47, July, 1993), Gopinath, et al. , proposed near-infrared spectroscopy to be used in the emergency room as an adjunct to computerized tomography (CT) or when CT is not immediately available. This proposition was