ICG-assisted blood vessel detection during stereotactic neurosurgery: Simulation study on excitation power limitations due to thermal effects in human brain tissue

SummaryBackgroundIntraoperative blood vessel detection based on intraluminal indocyanin-green (ICG) would allow to minimize the risk of blood vessel perforation during stereotactic brain tumor biopsy. For a fiber-based approach compatible with clinical conditions, the maximum tolerable excitation light power was derived from simulations of the thermal heat load on the tissue.MethodsUsing the simulation software LITCIT, the temperature distribution in human brain tissue was calculated as a function of time for realistic single-fiber probes (0.72 mm active diameter, numerical aperture 0.35, optional focusing to 0.29 mm diameter) and for the optimum ICG excitation wavelength of 785 nm. The asymptotic maximum temperature in the simulated tissue region was derived for different radiant fluxes at the distal fiber end. Worst case values were assumed for all other parameters. In addition to homogeneous (normal and tumor) brain tissue with homogeneous blood perfusion, models with localized extra blood vessels incorporated ahead of the distal fiber end were investigated.ResultsIf one demands that destruction of normal brain tissue must be excluded by limiting the tissue heating to 42 °C, then the radiant flux at the distal fiber end must be limited to 33 mW with and 43 mW without focusing. When considering extra blood vessels of 0.1 mm diameter incorporated into homogeneously perfused brain tissue, the tolerable radiant flux is reduced to 22 mW with and 32 mW without focusing. The threshold value according to legal laser safety regulations for human skin tissue is 28.5 mW.ConclusionsFor the envisaged modality of blood vessel detection, light power limits for an application-relevant fiber configuration were determined and found to be roughly consistent with present legal regulations for skin tissue.