Neurosurg Focus 32 (2):E2, 2012

Validation of frontal near-infrared spectroscopy as

noninvasive bedside monitoring for regional cerebral blood
I)@&-,&#!$-,7-,H?!"*&=$3-",3/
PHILIPP TAUSSKY, M.D.,1 BRANDON ONEAL, B.S., 6 WILSON P. DAUGHERTY, M.D., PH.D.,1
SOTHEAR LUKE, M.P.H., 2 DALLAS THORPE, B.S., 3 ROBERT A. POOLEY, PH.D., 3
CLAY EVANS, B.S.,7 RICARDO A. HANEL, M.D., PH.D.,1 AND WILLIAM D. FREEMAN, M.D.4,5
Departments of 1Neurosurgery, 2Neuroscience Research, 3Radiology, 4Neurology, and 5Critical Care, Mayo
Clinic, Jacksonville; 6University of North Florida College of Arts and Sciences, Jacksonville; and
7
University of South Florida College of Medicine, Tampa, Florida
Object. F"$!7-,>!$!"*&/=".3!)/.)=+&JFAG5K&)>>"!/&,),-,0$/-0"&#"*/-*"&("$/?!"(",3&)>&*-!".3&!"1-),$%&."!"#!$%&
$!3"!-)0",)?/&J(-6"*K&#!$-,&)6+1",$3-),4&9)&0$%-*$3"&3'"&$..?!$.+&)>&3'-/&(),-3)!-,1&3".',-L?":&3'"&$?3')!/&$,$%+M"*&
3'"&/3$3-/3-.$%&.)!!"%$3-),&)>&FAG5&$,*&89&="!>?/-),&@-3'&!"/=".3&3)&!"1-),$%&."!"#!$%&#%))*&I)@&J8CDK&("$/?!"ments.
Methods.&9'"&$?3')!/&!"3!)/=".3-0"%+&!"0-"@"*&$%%&.$/"/&-,&@'-.'&FAG5&("$/?!"(",3/&@"!"&)#3$-,"*&$3&$&/-,1%":&
$.$*"(-.&,"?!)-,3",/-0"&.$!"&?,-3&>!)(&D"#!?$!+&NOOP&3)&Q?,"&NORR&-,&@'-.'&89&="!>?/-),&@$/&="!>)!("*&$3&3'"&
/$("&3-("&$/&FAG5&*$3$&@$/&.)%%".3"*4&G"1-),/&)>&-,3"!"/3&@"!"&)#3$-,"*&N4S&.(&#"%)@&3'"&FAG5&#->!),3$%&/.$%=&
=!)#"&),&89&="!>?/-),&@-3'&$,&$0"!$1"&0)%?("&#"3@"",&N&$,*&T&(%:&@-3'&("$,&8CD&0$%?"/&?/"*&>)!&=?!=)/"/&)>&
$,$%+/-/4&U-,"$!&!"1!"//-),&$,$%+/-/&@$/&="!>)!("*&>)!&FAG5&$,*&8CD&0$%?"/4
Results.&9'"&/3?*+&-,.%?*"*&P&=$3-",3/&JN&(",:&V&@)(",K:&V&)>&@')(&/?>>"!"*&/?#$!$.',)-*&'"()!!'$1":&R&-/.'"(-.&/3!)W":&$,*&R&-,3!$."!"#!$%&'"()!!'$1"&$,*&#!$-,&"*"($4&X"$,&8CD&("$/?!"*&#+&89&="!>?/-),&@$/&VR&(%YROO&
1Y(-,&>)!&3'"&%">3&/-*"&$,*&VO&(%YROO&1Y(-,&>)!&3'"&!-1'3&/-*":&@'-%"&("$,&FAG5&0$%?"/&@"!"&ZS&),&3'"&!-1'3&$,*&ZT&),&
3'"&%">34&U-,"$!&!"1!"//-),&$,$%+/-/&*"(),/3!$3"*&$&/3$3-/3-.$%%+&/-1,-2.$,3&=!)#$#-%-3+&0$%?"&J=&[&O4OOORK&.)(=$!-,1&
FAG5&>!),3$%&)6-("3!+&$,*&89&="!>?/-),\)#3$-,"*&8CD&0$%?"/4
Conclusions.&9'"& $?3')!/& *"(),/3!$3"*& $& %-,"$!& .)!!"%$3-),& >)!& >!),3$%& FAG5& ."!"#!$%& )6+1",$3-),& ("$/?!"(",3/&.)(=$!"*&@-3'&!"1-),$%&8CD&),&89&="!>?/-),&-($1-,14&9'?/:&>!),3$%&FAG5&."!"#!$%&)6+1",$3-),&("$/?!"(",3&
may serve as a useful, noninvasive, bedside intensive care unit monitoring tool to assess brain oxygenation in a direct
manner.
(http://thejns.org/doi/abs/10.3171/2011.12.FOCUS11280)

KEY WORDS! ! "! ! #$%&'(#)&%&$*!+,$-.&/+-/,0! ! "! ! -$&$1&%2!/304$#%.(/#! ! "! !

-/5,6.$*!./5/4&%,70!,$&)6+(/#! ! "! ! -$&$1&%2!12//*!8/9

ARLY detection and correction of cerebral ischemia

is an essential part of the ICU treatment of patients
after traumatic brain injuries or hemorrhagic and
ischemic stroke.14,24 Current methods used to monitor ce!"#!$%&'"()*+,$(-./&'$0"&/-1,-2.$,3&%-(-3$3-),/4&53$#%"&
6",),7",'$,."*&89:&;<9:&5;<89:&)!&="!>?/-),7@"-1'3ed MR imaging requires transportation of a critically ill
=$3-",3:& @'-.'& -/& -(=!$.3-.$%& >)!& ()/3& A8B& /"33-,1/& $,*&

Abbreviations used in this paper:& 8CD& ]& ."!"#!$%& #%))*& >%)@^&

8C_& ]& ."!"#!$%& #%))*& 0)%?("^& A8`& ]& -,3!$."!"#!$%& '"()!!'$1"^&
X99&]&("$,&3!$,/-3&3-("^&FAG5&]&,"$!7-,>!$!"*&/=".3!)/.)=+^&5E`&
= subarachnoid hemorrhage.

Neurosurg Focus / Volume 32 / February 2012

carries the risk of clinical deterioration. Other bedside

methods such as jugular bulb oximetry indicate changes
-,&8CD&@-3')?3&*-!".3&("$/?!"(",3&)>&8CD4
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
)>&)6+1",$3"*&'"()1%)#-,&.)(=$!"*&@-3'&*")6+1",$3"*&
'"()1%)#-,4& E/& $& !"/?%3:& FAG5& =!)0-*"/& $& ,),-,0$/-0":&
real-time, bedside monitoring tool of cerebral oximetry
-,& .!-3-.$%%+& -%%& #!$-,7-,H?!"*& =$3-",3/& @-3')?3& "6=)/-,1&
patients to radiation. The correlation of CBF as measured
#+&FAG5&$,*&89&="!>?/-),&'$/&,)3&#"",&/3?*-"*&=!"0-)?/1

P. Taussky et al.
%+:&$,*&@"&'+=)3'"/-M"*&3'$3&3'"!"&-/&$&%-,"$!&.)!!"%$3-),&
#"3@"",& 8CD& $/& "0$%?$3"*& #+& FAG5& $,*& 89& ="!>?/-),&
("$/?!"(",3/:&@'-.'&@)?%*&0$%-*$3"&3'"&?/"&)>&FAG5&$/&
a noninvasive tool of direct CBF evaluation.

:$.7/*+
a"&!"3!)/=".3-0"%+&!"0-"@"*&$%%&=$3-",3/&$*(-33"*&3)&
the Mayo Clinic in Jacksonville, Florida, from February
NOOP& 3'!)?1'& Q?,"& NORR& @-3'& 5E`:& -/.'"(-.& /3!)W":& )!&
A8`&@')&?,*"!@",3&89&="!>?/-),&/3?*-"/4&8)(=?3"*&3)()1!$='+&="!>?/-),&@$/&="!>)!("*&$3&3'"&/$("&3-("&$/&
FAG5&*$3$&@"!"&.)%%".3"*4&9'"&89&="!>?/-),&("3')*&?/"/&
an iodinated contrast agent administered intravenously
@-3'& /?#/"L?",3& $.L?-/-3-),& )>& !"="$3"*& '-1'& 3"(=)!$%&
!"/)%?3-),&-($1"/4&E,&-,.!"$/"&-,&`)?,/"2"%*&?,-3/&.$,&
be measured in the intravascular and tissue beds. The
transient increase in radiation attenuation is proportional
to the amount of contrast in a given region and the speed
$3&@'-.'&3'"&$1",3&=$//"/&>!)(&$!3"!-$%&3)&0",)?/&.-!.?-3/&
through the tissue bed.9 The CT perfusion technique is
#$/"*&),&3'"&.",3!$%&0)%?("&=!-,.-=%":&@'-.'&!"%$3"/&8CD:&
8C_:&$,*&X99&-,&3'"&>)%%)@-,1&"L?$3-),b&8CD&]&8C_Y
MTT. Contrast agent time-concentration curves are generated in arterial and venous regions of interest and in
each pixel. Deconvolution of arterial and tissue enhancement curves provides the MTT. Cerebral blood volume is
calculated as the area under the curve in a parenchymal
pixel divided by the area under the curve in an arterial
pixel. The central volume equation can then be solved for
CBF.9
9'"&89&="!>?/-),&-($1"/&@"!"&$,$%+M"*&),&$&5-"(",/&
U"),$!*)& =)/3=!)."//-,1& @)!W/3$3-),4& 9'"& 89& ="!>?/-),&
!"1-),/&)>&-,3"!"/3&@"!"&)#3$-,"*&N4S&.(&#"%)@&3'"&FAG5&
>!),3$%& /.$%=& =!)#"/& @-3'& $,& $0"!$1"& !"1-),& )>& -,3"!"/3&
0)%?("&)>&N\T&(%4&9'"&89&="!>?/-),&*$3$&=$!$("3"!/&!"0-"@"*&-,.%?*"*&8CD:&8C_:&3-("&3)&*!$-,:&$,*&X994&X"$,&
0$%?"/&$,*&$0"!$1"&5c&@"!"&"/3$#%-/'"*&>)!&$%%&89&="!>?sion parameters.
C->!),3$%& FAG5& )=3)*"/& J8$/("*K& @"!"& =%$."*& ),&
the scalp per the manufacturers recommendations, sepa!$3"*& #+& $,& -,3"!)=3)*"& *-/3$,."& )>& T\S& .(4& 9'"& FAG5&
!"3!-"0"*&."!"#!$%&)6-("3!+&0$%?"/&N4S&.(&>!)(&3'"&%"0"%&
of the scalp for bifrontal hemispheres. The data received
@"!"&.)(=$!"*&@-3'&3'"&89&="!>?/-),&*$3$4&C)3'&89&="!>?/-),&$,*&FAG5&@"!"&?/"*&@-3'-,&$/&.%)/"&$&3-("&>!$("&
as possible (! 2 hours apart or ideally !&dN&(-,?3"/K&3)&",/?!"&.)(=$!$#%"&/3?*+&*$3$4&9'"&FAG5&."!"#!$%&)6-("3!+&
data recorded closest in time to the complete CT perfu/-),&"6$(-,$3-),&@"!"&$,$%+M"*4
8)(=$!$3-0"&*$3$&$,$%+/-/&@$/&="!>)!("*&?/-,1&3'"&
e!$=';$*& ;!-/(& /3$3-/3-./& /)>3@$!"4& E& %-,"$!& !"1!"//-),&
$,$%+/-/&@$/&="!>)!("*&>)!&$&f#"/3&23g&/3$,*$!*&hSi&8A&
$,$%+/-/4&53$3-/3-.$%&/-1,-2.$,."&@$/&*"2,"*&$/&=&[&O4OS4

;$+62.+
j>&RNPZ&=$3-",3/&$*(-33"*&3)&3'"&,"?!)/.-",."&A8B&)!&
')/=-3$%&*?!-,1&3'"&/3?*+&="!-)*&@-3'&5E`:&A8`:&)!&/3!)W"7
!"%$3"*&*-$1,)/-/:&@"&-*",3-2"*&RV&*$3$&/"3/&>!)(&P&=$-!"*&
"6$(-,$3-),/&)>&89&="!>?/-),&0"!/?/&FAG5&."!"#!$%&)6-(2

etry that met study criteria. Patient demographic data in.%?*"*&N&(",&$,*&V&@)(",&@-3'&$&("$,&$1"&)>&VP4T&+"$!/&

J!$,1"&TZ\PV&+"$!/K4&5-6&=$3-",3/&/?>>"!"*&5E`:&R&'$*&-/.'"(-.&/3!)W":&$,*&R&'$*&A8`&$,*&#!$-,&"*"($4&X"$,&0$%?"/&
"/3$#%-/'"*&>)!&8CD&-,&3'"&89&="!>?/-),&/3?*+&@"!"&VR4N&
"&NR4NP&(%YROO&1Y(-,&J!$,1"&Td4V\ZV4T&(%YROO&1Y(-,K&>)!&
the left hemisphere and 60.2 "&NR4NR&(%YROO&1Y(-,&J!$,1"&
Td4T\ZZ4T& (%YROO& 1Y(-,K& >)!& 3'"& !-1'3& '"(-/='"!"4& X"$,&
8C_/& @"!"& d4NS& "& R4OT& (%& J!$,1"& N4dT\d4hd& (%K& >)!& 3'"&
%">3&$,*&d4NZ&"&R4OO&(%&J!$,1"&N4Nh\T4TP&(%K&>)!&3'"&!-1'34&
9'"&("$,&)>&X99&@$/&d4dN&"&O4ZOh&/".),*/&J!$,1"&d4OR\
d4ZP&/".),*/K&>)!&3'"&%">3&$,*&d4TS&"&O4PdZ&/".),*/&J!$,1"&
d4OR\T4NN&/".),*/K&>)!&3'"&!-1'34&9'"&("$,&3-("&3)&*!$-,&
@$/& d4hV& "& O4VhT& /".),*/& J!$,1"& N4VS\T4hh& /".),*/K& >)!&
3'"&%">3&$,*&T4OZ&"&O4hTN&/".),*/&J!$,1"&N4SZ\S4RS&/".),*/K&
>)!&3'"&!-1'34&9'"&*$3$&.)%%".3"*&#+&3'"&FAG5&*"0-."&@"!"&
$/&>)%%)@/b&("$,&0$%?"&>)!&%">3&>!),3$%&)6-("3!+&@$/&ZT4S&"
h4ON&)6-("3!+&?,-3/&J!$,1"&VO\PZ&)6-("3!+&?,-3/K&$,*&ZS4N&
"&RO4Z&)6-("3!+&?,-3/&J!$,1"&SV\PT&)6-("3!+&?,-3/K&>)!&3'"&
right. Analysis of the linear regression revealed a p value
[&O4OOOR&.)(=$!-,1&FAG5&>!),3$%&)6-("3!+&$,*&89&="!>?/-),\)#3$-,"*&8CD&0$%?"/&JD-14&RK4

<(+-6++(/#
a"& >)?,*& $& %-,"$!& .)!!"%$3-),& #"3@"",& 3'"& ?/"& )>&
>!),3$%& FAG5& ."!"#!$%& )6+1",$3-),& $,*& >!),3$%& 8CD& $/&
measured by the CT perfusion method. This association
'$/&,)3&#"",&!"=)!3"*&-,&$,+&=!-)!&'?($,&/3?*-"/&3'$3&@"&
.)?%*& 2,*& $,*& 0$%-*$3"/& 3'"& $..?!$.+& )>& 8CD& ("$/?!"(",3&#+&FAG54
Near-infrared spectroscopy oximetry has been evaluated in the use of vasospasm,10& #?3& ,)3& *-!".3%+& @-3'& 89&
="!>?/-),& 8CD4& 9'"/"& =!"0-)?/& "0$%?$3-),/& @"!"& $,-($%&
/3?*-"/& ?/-,1& FAG5& @-3'& -,*).+$,-,"& 1!"",& -,& =-1%"3/2,16
and other experiments.R:S:V:RO:Rh We believe that our data,
$%3')?1'&/($%%&-,&,?(#"!:&($+&0$%-*$3"&3'"&?/"&)>&FAG5&
as an important noninvasive real-time bedside application
>)!&FAG5&-,&.!-3-.$%%+&-%%&#!$-,7-,H?!"*&=$3-",3/&@')&$!"&3))&
unstable to transport to a CT scanner for the CT perfusionderived method. Near-infrared spectroscopy has the additional advantage of not exposing patients to radiation, a
.),."!,&3'$3&-/&/-1,-2.$,3&-,&=$3-",3/&?,*"!1)-,1&,?("!)?/&
CT perfusion scans during prolonged ICU stays.
5)("&-,'"!",3&3".',-.$%&%-(-3$3-),/&)>&FAG5&,""*&3)&
#"&$**!"//"*4&8"!"#!$%&#%))*&I)@&("$/?!"(",3/&$!"&)>&$&
regional nature, in contrast to CT perfusion and xenon",'$,."*&89:&@'-.'&$%%)@&$&()!"&1%)#$%&$//"//(",3&)>&
#!$-,&="!>?/-),4&E%/):&FAG5&("$/?!"*&$==!)6-($3"%+&N4S&
.(& *)@,& >!)(& 3'"& /W-,& %"0"%:& @'-.'& @$/& *-!".3%+& .)(=$!"*&@-3'&!"1-),/&)>&-,3"!"/3&),&3'"&89&="!>?/-),7*"!-0"*&
regional CBF.3& 9'-/& -,>)!($3-),& (?/3& #"& !"1$!*"*& @-3'&
caution by clinicians. Regional information such as inva/-0"&#!$-,&3-//?"&)6+1",$3-),&J>)!&"6$(=%"K:&U-.)6&=!)#"/:&
$,*&."!"#!$%&(-.!)*-$%+/-/&=!)#"/&*)&,)3&$%@$+/&.)!!"%$3"&
@-3'&1%)#$%&."!"#!$%&("3$#)%-.&/3$3"/&)!&"0",&'"(-/='"!-.&
/3$3"/&$,*&$!"&/)("3-("/&0"!+&/=".-2.&3)&3'"&!"1-),&)>&-,jured brain. In Fig. 2, for example, in the upper left image,
3'"&=)/3"!-)!&!-1'3&'"(-/='"!"&/')@/&$&'"()!!'$1"&@-3'&
/?!!)?,*-,1&"*"($&$,*&%)@&8CD:&@'-.'&@)?%*&#"&(-//"*&
#+&$&%">3&>!),3$%&FAG5&)6+1",$3-),&("$/?!"(",34
Neurosurg Focus / Volume 32 / February 2012

FAG5&(),-3)!-,1&>)!&!"1-),$%&8CD&-,&#!$-,7-,H?!"*&=$3-",3/

FIG. 1. Linear regression analysis comparing NIRS frontal oximetry and CT perfusionobtained CBF values (p < 0.0001). The
solid line represents the linear regression line and the dashed line represents the 95% CI. Twenty-two data points are shown
because 3 patients underwent 2 CT perfusions with NIRS correlation.

Other methods of CBF measurement exist and their

relative advantages and disadvantages are noted in Table
1. The CT perfusion method is a commonly used method
in the neurointensive care unit, using iodinated contrast
to measure CBF, due to its ease of use, speed of imaging,
$,*& @-*"& $0$-%$#-%-3+46,21,22 `)@"0"!:& $.L?-!-,1& ("$/?!"ments by means of CT perfusion requires transportation
)>&.!-3-.$%%+&-%%&=$3-",3/:&@'-.'&=)/"/&=$3-",3&/$>"3+&!-/W/&
of invasive catheter dislodgement (central venous lines
)!&-,0$/-0"&#!$-,&.$3'"3"!/Y=!)#"/K:&%)@"!-,1&3'"&'"$*&)>&
the bed during transport (increasing the risk of ventilatorassociated pneumonia or raised intracranial pressure in
=$3-",3/& @-3'& #)!*"!%-,"& -,3!$.!$,-$%& .)(=%-$,."K:& "6=)/?!"&3)&-),-M-,1&!$*-$3-),:&$,*&!-/W&)>&=)//-#%"&$%%"!1-.&)!&
anaphylactic reaction due to iodinated contrast material,
or even contrast-induced nephropathy.RS:Nd The peak dose
>!)(&-),-M-,1&!$*-$3-),&-,&89&="!>?/-),&-/&$==!)6-($3"%+&
dNS\TdS&(e+&$,*&*"=",*/&),&($,+&>$.3)!/&-,.%?*-,1&$.quisition technique and type of scanner.21 Early transient
erythema may occur in some patients at a skin dose of
2000 mGy.Z It is apparent that several CT perfusion scans
in a short period of time could cause transient erythe($&$,*&"0",&f/3!-="&$%)=".-$4gZ There has been increas-,1&/.!?3-,+&#+&3'"&=?#%-.&)>&!$*-$3-),&*)/-,1&@-3'-,&3'"&

hospital.Z Xenon-enhanced CT is another method used to

measure CBF and is regarded as a potential gold standard
for regional CBF measurement due to its superior spatial resolution, accuracy, and reproducibility.V:RZ&`)@"0"!:&
6",),7*"!-0"*&8CD&)!&6",),7",'$,."*&89&-/&,)3&@-*"%+&
$0$-%$#%"&-,&($,+&A8B/4&E%/):&6",),&'$/&#"",&W,)@,&3)&
#"& $& 0$/)*-%$3)!& $,*& ($+& -,.!"$/"& 8CD& J?=& 3)& ROOiK48
j,"&W"+&$*0$,3$1"&)>&3'"&?/"&)>&FAG5&-/&-3/&$0$-%$#-%-3+&
to be performed at the bedside, even in unstable patients
@')&.$,,)3&#"&3!$,/=)!3"*&3)&3'"&89&/?-3"412
Another method of measuring cerebral O2 metabolism is the jugular venous catheter and jugular venous O2
saturation by placement of a venous catheter into the internal jugular vein in the patients neck. Jugular venous
O2 saturation estimates jugular venous oxygenation via a
H?1?%$!& 0"-,& .$3'"3"!& )6-("3"!& @-3'-,& 3'"& -,3"!,$%& H?1?%$!& 0"-,& $,*& 3+=-.$%%+& !"L?-!"/& !".$%-#!$3-),& "0"!+& P\RN&
hours.21 Jugular venous O2 saturation can provide an indi!".3&("$/?!"(",3&)>&8CD&#+&f/?==%+&$,*&*"($,*&='+/-)%)1+g& /-(-%$!& 3)& FAG5:& $%#"-3& @-3'& /)("& *->>"!",."/&
"6=%$-,"*& #"%)@4& a'",& H?1?%$!& 0",)?/& j2 saturation is
%)@& J[& SOi& >)!& k& RO& (-,?3"/& -,& *?!$3-),K:& -3& 1","!$%%+&
-,*-.$3"/&*".!"$/"*&f/?==%+&='+/-)%)1+g&/?.'&$/&0"!+&%)@&
'"()1%)#-,& *"2,"*& #+& 3'"& *"%-0"!+& )>& j2& "L?$3-),b& *"-

TABLE 1: Different methods of CBF measurement

Method of CBF
Measurement
Kety-Schmidt model
xenon-enhanced CT
CT perfusion

Advantages

Disadvantages

reliable measurement of global CBF

accurate, high spatial quality, extensively researched4
perhaps more widely used than xenon-enhanced CT,
! "#$%&'()*!+,-.!+,/.!011.!2!&'3)!&4!5)$6 26

PET

25

standardized, quantitative measurements of CBF &

! +,/.!)78)99)%&!*5$&'$9!:)*49#&'4%26
MRI w/ perfusion-weighted can demonstrate structural brain changes as well as
imaging
perfusion, & does not require use of ionizing radia! &'4%;!3)$*#:)*!+,-.!+,/.!011.!2!&'3)!&4!5)$613,26
NIRS w/ indocyanine green noninvasive, no major side effects reported w/ use5
dye (animals)

Neurosurg Focus / Volume 32 / February 2012

inhalation mixture of O2 & N2O25

not widely available, xenon known as a vasodilator19
x-ray exposure, bolus injection of iodine dye (dye allergy & anaphylactic risks), risk of contrast nephropathy, & transportation of critically ill4
not widely available to most ICUs, radioactive components26
Gd intravenous contrast agent administration, may be problematic in renal failure, longer scan time vs CT26
not standardized in humans, complex distortion by skin tissue2

P. Taussky et al.

FIG. 2. Axial CT head and CT perfusion images of all 8 patients included in the study.

livery of O2 = cardiac output # carrying capacity of O2.

The carrying capacity of O2&-/&>?!3'"!&*"2,"*&$/&>)%%)@/b&
(hemoglobin # 1.36 # saturation of O2K&$ (partial pressure
of O2 #&O4OOdRK4&j3'"!&%)@&f/?==%+g&='+/-)%)1-.$%&.),/-*"!$3-),/&-,.%?*"&%)@&.$!*-$.&)?3=?3&)!&=))!&)6+1",$3-),&
via the variables partial pressure of O2:&%)@&'"()1%)#-,:&
or saturation of O2. Conversely, an increase in cerebral
("3$#)%-/(&J-,.!"$/"*&*"($,*K&.$,&/-(-%$!%+&.'$,1"&3'"&
jugular venous O2&/$3?!$3-),&J)!&FAG5K&#+&-,.!"$/"*&."rebral consumption of O2 or increased O2 extraction fraction. In fact, the arteriovenous O2 content difference (carrying capacity of O2 % the venous O2&.),3",3&)>&3'"&#%))*K&
4

(?%3-=%-"*&#+&3'"&.$!*-$.&)?3=?3&-/&*"2,"*&$/&j2 demand
by the Fick Principle.21&c)@,/-*"/&3)&H?1?%$!&0",)?/&j2
saturation monitoring include invasive venous puncture
$,*&!-/W/&)>&.",3!$%&#%))*/3!"$(7!"%$3"*&-,>".3-),&J@'-.'&
-/&$&,$3-),$%&#",.'($!W&)>&-,=$3-",3&L?$%-3+K:&H?1?%$!&0"-,&
thrombosis, and potential raised intracranial pressure
>!)(&H?1?%$!&0",)?/&)?3I)@&)#/3!?.3-),413
9'"& FAG5& ("3')*& -/& $,& "("!1-,1& 3".',)%)1+& >)!&
measuring O2 content via near-infrared light (approxi($3"%+&VOO\hOO&,(K&)!-1-,$%%+&*"/.!-#"*&#+&Q)#/-/:11 in
@'-.'& ,"$!7-,>!$!"*& %-1'3& "(-33"*& %-1'3& 3'!)?1'& $& .$3l/&
head. Neural activity is ultimately fueled by glucoseNeurosurg Focus / Volume 32 / February 2012

FAG5&(),-3)!-,1&>)!&!"1-),$%&8CD&-,&#!$-,7-,H?!"*&=$3-",3/
oxidative metabolism and is dependent upon delivery of
oxygenated hemoglobin transported from the blood to the
tissue and results in exchange of oxygenated hemoglobin
to the deoxygenated hemoglobin form.21 In mammals, he()1%)#-,& -/& $& /3!),1& f.'!)()=')!"g& )!& %-1'37$#/)!#-,1&
molecule. Oxygenated and deoxygenated hemoglobin
.),/-/3& )>& *->>"!",3& )=3-.$%& $#/)!#-,1& =!)="!3-"/:& @'-.'&
$%%)@/&>)!&-3/&*"3".3-),&#+&FAG5^&3'"&($6-(?(&$#/)!=tion of oxygenated hemoglobin is approximately 900 nm
)>&,"$!7-,>!$!"*&%-1'3&$,*&-/&$==!)6-($3"%+&ZVO&,(&-,&*"oxygenated hemoglobin.3 Lambert-Beer described a relationship that is a ratio of oxygenated hemoglobin versus
*")6+1",$3"*& '"()1%)#-,& 0-$& FAG5& 3".',)%)1+& $,*& -/&
?/"*& -,& .)(("!.-$%& $,*& =$3",37/=".-2.& FAG5& ("$/?!"ment algorithms.20
E)+$1-&*"/.!-#"*&3'"&FAG5&("3')*&>)!&-/)%$3-,1&$!terial O2&/$3?!$3-),:&@'-.'&@$/&*"/.!-#"*&-,&RhPS418 This
noninvasive technology has emerged as a fairly ubiquitous tool for anesthesia and intraoperative, noninvasive,
O2 saturation monitoring to detect desaturation events in
$& !"$%73-("& >$/'-),4& 9'"!">)!":& ."!"#!$%& FAG5& ("$/?!"/&
combined arteriovenous oxygenated hemoglobin satura3-),&JRYd&$!3"!-$%&$,*&NYd&0",)?/K:&@'-.'&'$/&0$%?"/&3'$3&
are higher than jugular venous O2 saturation data and
3!",*&?=&$,*&*)@,&*"=",*-,1&),&/?==%+&$,*&*"($,*&."!"#!$%&='+/-)%)1+4&9'"&FAG5&%-1'3&-/&"(-33"*&$3&3'"&%"0"%&
of the scalp, but measures deeper cerebral brain oxygen$3-),& 0-$& $& f/=$3-$%%+& !"/)%0"*& )=3)*"& 3".',-L?"4g& 9@)&
)=3)*"/&$!"&/"=$!$3"*&#+&$&2,-3"&*-/3$,."&>!)(&3'"&%-1'3&
"(-33"!:& $,*& 3'"& .%)/"!& )=3)*"& ("$/?!"/& 3'"& /?="!2.-$%&
/.$%=& 3-//?"/l& .),3!-#?3-),& 3)& 3-//?"& )6+1",$3-),:& @'-.'&
is then subtracted from the distal optode measurement,
@'-.'& !"."-0"/& *""="!& .)!3-.$%7/?#.)!3-.$%& #!$-,& 3-//?"&
information.3,4,21
9'"!">)!":& FAG5& -,*-!".3%+& ("$/?!"/& 8CD& 0-$& /?=ply and demand cerebral O2 consumption and O2 deliv"!+:& #?3& ,)3& $.3?$%& 8CD& *-!".3%+4& `)@"0"!:& FAG5& )6-(etry can indirectly assess CBF via a surrogate technique,
@'-.'&.$,&=!)0-*"&/)("&$//"//(",3&)>&."!"#!$%&-/.'"(-$&
and physiology. To date, the isolation of the pure brain
$!3"!-$%&)6+1",$3-),&/$3?!$3-),&0-$&3'"&,),-,0$/-0"&FAG5&
("3')*&!"($-,/&*->2.?%3&*?"&3)&.),3$(-,$3-),&)>&/.$%=:&
bone, and tissues external to underlying brain tissue. The
."!"#!$%& )6-("3!+& *"0-."/& '$0"& *->2.?%3+& -/)%$3-,1& 3'"&
=?%/$3-%"&$!3"!-$%&@$0">)!(&3'$3&-/&*-/3-,.3&>!)(&"63!$."!"#!$%&3-//?"&.)(=$!"*&@-3'&3'"&f2,1"!&$!3"!-$%&/$3?!$3-),&
*"0-."/g& 3'$3& $!"& .)(("!.-$%%+& $0$-%$#%"& $,*& )!-1-,$%%+&
derived from Aoyagis invention.13&9'"&FAG5&."!"#!$%&)6-("3!+&3".',)%)1+&,),"3'"%"//&=!)0-*"/&.%-,-.-$,/&@-3'&$&
potentially useful method of indirectly assessing regional
CBF that is noninvasive and provides some insight into
neurometabolic states.
This study demonstrates that CT perfusion CBF has
$& /-1,-2.$,3& %-,"$!& .)!!"%$3-),& @-3'& FAG5& ("$/?!"(",3&
J=& k& O4OOORK:& $%3')?1'& @-3'& /"0"!$%& %-(-3$3-),/4& 9'"/"&
%-(-3$3-),/&-,.%?*"&3'"&/($%%&/$(=%"&/-M":&$&!"3!)/=".3-0"&
study design, and lack of a baseline comparative study
#"3@"",& 89& ="!>?/-),& $,*& FAG5& ("3')*)%)1+4& F"$!7
infrared spectroscopy is also limited by the thickness of
3'"&/W?%%&)!&>!),3$%&/.$%=&/@"%%-,1&$>3"!&.!$,-)3)(+:&@'-.'&
increases the distance from the light emitter and deeper
Neurosurg Focus / Volume 32 / February 2012

tissues and can be further distorted if large amounts of

85D&$!"&=!"/",3&#"3@"",&/W-,&$,*&#!$-,&3-//?"&)!&?,*"!%+ing severe brain atrophy.12&E%/):&FAG5&/",/)!/&$!"&=%$."*&
-,&3'"&>!),3$%&'"$*&%).$3-),&),%+:&@'-.'&.)?%*&.)(=%-.$3"&
the estimation of the exact region of interest in CT perfusion imaging based on the depth from the optodes and
=","3!$3-),&)>&FAG5&%-1'34
<(+-2/+6&$
c!4&`$,"%&/"!0"/&$/&$&.),/?%3$,3&3)&F"?!)_$/6&$,*&8)*($,4
Author contributions to the study and manuscript preparation
-,.%?*"&3'"&>)%%)@-,14&8),."=3-),&$,*&*"/-1,b&9$?//W+:&c$?1'"!3+:&
;))%"+:& <0$,/:& `$,"%:& D!""($,4& E.L?-/-3-),& )>& *$3$b& 9$?//W+:&
ONeal, Luke, Thorpe, Pooley, Freeman. Analysis and interpretation
)>& *$3$b& 9$?//W+:& jlF"$%:& 9')!=":& D!""($,4& c!$>3-,1& 3'"& $!3-.%"b&
9$?//W+:&jlF"$%:&D!""($,4&8!-3-.$%%+&!"0-/-,1&3'"&$!3-.%"b&9$?//W+:&
jlF"$%:&`$,"%:&D!""($,4&G"0-"@"*&/?#(-33"*&0"!/-),&)>&($,?/.!-=3b&
9$?//W+:& jlF"$%:& U?W":& 9')!=":& ;))%"+:& <0$,/:& `$,"%:& D!""($,4&
E==!)0"*&3'"&>-,$%&0"!/-),&)>&3'"&($,?/.!-=3&),&#"'$%>&)>&$%%&$?3')!/b&
9$?//W+4&53$3-/3-.$%&$,$%+/-/b&9$?//W+:&U?W"4&E*(-,-/3!$3-0"Y3".',-.$%Y($3"!-$%&/?==)!3b&9')!="4
;$)$&$#-$+
& R4& C"%%$,-& X:& ;"!?MM)& c:& A/)%$& X:& G$(#$%*"%%-& e:& ;"!%-,-& 8:&
C$-$,)& X:& "3& $%b& 8"!"#"%%$!& $,*& %)#$!& #%))*& I)@& -,& /.'-M)='!",-$b&$&="!>?/-),&@"-1'3"*&-($1-,1&/3?*+4&=+0-7(%.&0!;$+
193:TV\SN:&NORR
& N4& C!)@,&ca:&;-.)3&;E:&F$"-,-&Qe:&5=!-,1"33&G:&c"%=+&c9:&U""&
9mb&n?$,3-3$3-0"&,"$!&-,>!$!"*&/=".3!)/.)=+&("$/?!"(",3&)>&
."!"#!$%&'"()*+,$(-./&-,&,"@#)!,&=-1%"3/4&=$*(%.&!;$+ 51:
SVT\SZO:&NOON
& d4& C?,."&58:&AMM"3)1%?&X:&AMM"3)1%?&o:&j,$!$%&C:&;)?!!"M$"-&ob&
Functional near-infrared spectroscopy. >???!?#4!:$*!@(/2!
:%4 25:ST\VN:&NOOV
& T4& C??,W& e:& 0$,& *"!& `)"0",& Qe:& X"-,*"!/& E<b& E& .)(=$!-/),&
of near-infrared spectroscopy and jugular bulb oximetry in
comatose patients resuscitated from a cardiac arrest. A#%$+'
.7$+(% 53:Rd\Rh:&RhhP
& S4& 8$/$3-&E:&5=!"$2.)&<:&;?3M?&X:&D$,"%%-&eb&F"@&3".',)%)1+&
>)!&,),-,0$/-0"&#!$-,&(),-3)!-,1b&.),3-,?)?/&."!"#!$%&)6-(etry. :(#$&B%!A#$+.$+(/2 72:VOS\VNS:&NOOV
6. Gaudiello F, Colangelo V, Bolacchi F, Melis M, Gandini R, Ga!$.-&De:&"3&$%b&5-63+7>)?!7/".3-),&89&."!"#!$%&="!>?/-),&"0$%?$3-),& -,& =$3-",3/& @-3'& .$!)3-*& $!3"!+& /3",)/-/& #">)!"& $,*& $>3"!&
/3",3-,1&@-3'&$&."!"#!$%&=!)3".3-),&*"0-."4&AJNR Am J Neu'
&/&%*(/2 29:hRh\hNd:&NOOP
& Z4& e"%"-H,/&Q:&a),*"!1"(&Qb&p7!$+&-($1-,1&$,*&3'"&/W-,b&!$*-$tion biology, patient dosimetry and observed effects. ;%*(%.!
=&/.!</+(5$.&0 114:RNR\RNS:&NOOS
& P4& e-%%"!&8E:&;?!*+&;:&U-,*/3!)(&aab&<>>".3/&)>&-,'$%"*&/3$#%"&
6",),&),&."!"#!$%&#%))*&I)@&0"%).-3+4&AJNR Am J Neuro'
&%*(/2 11:RZZ\RPN:&RhhO
& h4& `)">>,"!&<e:&8$/"&A:&Q$-,&G:&e?H$!&5o:&5'$'&e_:&c"0"-W-/&Q;:&
"3&$%b&8"!"#!$%&="!>?/-),&89b&3".',-L?"&$,*&.%-,-.$%&$==%-.$tions. ;%*(/2/40 231:VdN\VTT:&NOOT
RO4& Q$"1"!&X:&5.'?'($,,&XB:&5)"'%"&X:&F$1"%&8:&X"-6",/#"!1"!&Qb&8),3-,?)?/&(),-3)!-,1&)>&."!"#!)0$/.?%$!&$?3)!"1?%$3-),&
after subarachnoid hemorrhage by brain tissue oxygen pressure reactivity and its relation to delayed cerebral infarction.
C.&/D$ 38:hPR\hPV:&NOOZ
RR4& Qq#/-/& DDb& F),-,0$/-0":& -,>!$!"*& (),-3)!-,1& )>& ."!"#!$%& $,*&
(+).$!*-$%& )6+1",& /?>2.-",.+& $,*& .-!.?%$3)!+& =$!$("3"!/4&
C-($#-$ 198:RNVT\RNVZ:&RhZZ
RN4& o?!3'&8c:&B'"!&Cb&8"!"#!$%&'"()1%)#-,&$,*&)=3-.$%&=$3'%",13'&
-,I?",."&,"$!7-,>!$!"*&/=".3!)/.)=+&("$/?!"(",3&)>&."!"#!$%&
oxygen saturation. A#$+.7!A#%24 84:RNhZ\RdOS:&RhhZ

P. Taussky et al.
Rd4& U"X$/3"!&8`:&5.'??!&Qc:&;$,*+$&c:&;$%%-,&cQ:&5-%0-$&Q:&m)W)"&c:&"3&$%b&A,>".3-),&$,*&,$3?!$%&'-/3)!+&)>&"("!1",.+&*"partment-placed central venous catheters. A##!?5$&4!:$*
56:ThN\ThZ:&NORO
RT4& X$MM")& E9:& C?%%).W& Gb& X),-3)!-,1& #!$-,& 3-//?"& )6+("3!+b&
@-%%& -3& .'$,1"& ($,$1"(",3& )>& .!-3-.$%%+& -%%& ,"?!)%)1-.& =$tients? E!F$6&/2!C-( 261:R\h:&NOOZ
RS4& X)!.)/&5ob&G"0-"@&$!3-.%"b&E.?3"&/"!-)?/&$,*&>$3$%&!"$.3-),/&
3)&.),3!$/3&("*-$b&)?!&.?!!",3&?,*"!/3$,*-,14&@&!E!;%*(/2 78:
VPV\Vhd:&NOOS
RV4& ;""3"!/75.')%3"&8:&0$,&*",&9@""%&<:&e!)",",*$$%&D:&0$,&C"%&
Db&G"*)6&/3$3"&)>&,"$!&-,>!$!"*&/=".3!)/.)=+7("$/?!"*&.+3).'!)("&$$JdK&.)!!"%$3"/&@-3'&*"%$+"*&."!"#!$%&","!1+&>$-%?!"&
>)%%)@-,1& ="!-,$3$%& '+=)6-$7-/.'$"(-$& -,& 3'"& ,"@#)!,& =-14&
?3,!@&%(#!;$+ 156:NO\NV:&NOOT
RZ4& 5.'?#"!3&eE:&a"-,($,,&8:&5"-M&X:&e"!-1W&U:&a"-//&8:&`)!,&
;:&"3&$%b&8"!"#!)0$/.?%$!&-,/?>2.-",.+&$/&3'"&.!-3"!-),&>)!&!"0$/.?%$!-M$3-),&=!)."*?!"/&-,&/"%".3"*&=$3-",3/b&$&.)!!"%$3-),&
study of xenon contrast-enhanced CT and PWI. Neurosurg
;$B!GHINh\dV:&NOOh
RP4& 5"0"!-,1'$?/&Qab&9$W?)&E)+$1-b&*-/.)0"!+&)>&=?%/"&)6-("3!+4&
A#$+.7!A#%24 105 (6 C6,,2JI5R\5T:&NOOZ
Rh4& 9"!#)!1&8:&C!$("!&5:&`$!/.'"!&5:&5-(),&X:&a-33"&jab&C"*side assessment of cerebral perfusion reductions in patients
@-3'& $.?3"& -/.'$"(-.& /3!)W"& #+& ,"$!7-,>!$!"*& /=".3!)/.)=+&
and indocyanine green. E!F$6&/2!F$6&/+6&4!=+0-7(%.&0 75:
dP\TN:&NOOT
NO4& B("+$($& 5:& m$($*$& 9b& F"@& ("3')*& )>& "/3-($3-,1& @$0"-

length-dependent optical path length ratios for oxy- and deoxyhemoglobin measurement using near-infrared spectroscopy. E!@(/5$*!K,. 14:OSTOdP:&NOOh
NR4& a$1,"!& Uo:& <->"%& ;Q:& e"-/"& GEb& ;)3",3-$%& #-)%)1-.$%& ">>".3/&
>)%%)@-,1&'-1'&p7!$+&*)/"&-,3"!0",3-),$%&=!)."*?!"/4&E!L%+-!
>#.$&B!;%*(/2 5:ZR\PT:&RhhT
NN4& a$!*%$@&QX:&X-"%W"&jb&<$!%+&/-1,/&)>&#!$-,&-,>$!.3-),&$3&89b&
observer reliability and outcome after thrombolytic treatment
/+/3"($3-.&!"0-"@4&;%*(/2/40 235:TTT\TSd:&NOOS
Nd4& a$!3",#"!1&o<:&5.'(-*3&QX:&X$+"!&5Eb&X?%3-()*$%-3+&(),-toring in neurocritical care. M&(.!M%&$!M2(# 23:SOZ\SdP:&NOOZ
24. Wintermark M, Albers GW, Alexandrov AV, Alger JR, Bam("!&G:&C$!),&Q8:&"3&$%b&E.?3"&/3!)W"&-($1-,1&!"/"$!.'&!)$*map. AEF;!A5!E!F$6&/&%*(/2 29:"Nd\"dO:&NOOP
NS4& a),1&;8:&U-&r:&e?)&Q:&r'$,1&Eb&;$3')='+/-)%)1+&)>&.),3!$/37
induced nephropathy. >#.!E!M%&*(/2 [epub ahead of print], 2011
NV4& r$?,"!& E:& c$?1'"!3+& a;:& C?%%).W& XG:& a$!,"!& c5b& C!$-,&
)6+1",$3-),& $,*& ","!1+& ("3$#)%-/(b& =$!3& A7#-)%)1-.$%& >?,.tion and pathophysiology. F$6&/+6&4$&0 51:NPh\dON:&NOON
X$,?/.!-=3&/?#(-33"*&j.3)#"!&RZ:&NORR4
Accepted December 2, 2011.
;%"$/"& -,.%?*"& 3'-/& -,>)!($3-),& @'",& .-3-,1& 3'-/& =$="!b& cjAb&
RO4dRZRYNORR4RN4Dj8B5RRNPO4&
Address correspondence to: Philipp Taussky, M.D., Department
)>&F"?!)/?!1"!+:&X$+)&8%-,-.:&TSOO&5$,&;$#%)&G)$*:&Q$.W/),0-%%":&
D%)!-*$&dNNNT4&"($-%b&='-%-==43$?//W+s1($-%4.)(4

Neurosurg Focus / Volume 32 / February 2012