Use of intraoperative dynamic infrared imaging with detection wavelength of 7-14 μm in the surgical obliteration of spinal arteriovenous fistula: Case report and technical considerations

Background and Objective: Although improvements of spatial and temporal resolution in infrared (IR) imaging have enabled intraoperative real-time acquisition of physiological and pathological information on living organs, the imaging qualities of anatomical delineation of blood vessels and functional delineation of blood flow were insufficient to serve as visual monitoring. The main reason was partly due to the lack of an appropriate IR detection IR band (formerly 3-5μm), and the broad dynamic range in previous modalities. Methods: To make a good contrast between blood vessels and surrounding tissues, the detection wavelength was shifted to the long-wave (7-14 μm) part of IR spectrum, which includes the peak IR wave from living tissue (9-10 μm), and the dynamic range was confined to ± 10 °C around 35 °C. The novel camera system (IRIS IV infrared imaging system) was used for the visual monitoring of blood flow during the obliteration of a spinal perimedullary arteriovenous fistula at Th 7 in 71-year-old male patient. The temperature resolution of camera was 0.15 °C, with its intensity resolution of 16 bit (320 x 240 pixels), and data were stored at a rate of 30 frames/second. High-quality delineation of blood vessels and blood flow was obtained all through the procedure without use of cold saline, which was an inevitable procedure to make contrast in the previously used thermography. However, the occasional use of an air blower was helpful to achieve adequate images in the deep and narrow area of the surgical field. The amount of shunt flow reduction was visualized by the intensity in the acquired imaging, which was also confirmed later by digital subtraction angiography. Conclusion: From the present experience, it is considered that this type of imaging may be able to substitute intraoperative blood vessel and blood flow monitoring in spinal and other neurosurgical disorders.