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Thinned-skull Cortical Window Technique for In Vivo Optical Coherence Tomography Imaging
Published on: November 19, 2012
Post-mortem imaging of the infant and perinatal dura mater and superior sagittal sinus using optical coherence
Emma C Cheshire1, Roger D G Malcomson2, Shiju Joseph3
1East Midlands Forensic Pathology Unit, University of Leicester, Robert Kilpatrick Building, Level 3 Leicester Royal Infirmary, Leicester, LE2 7LX, UK. ecc25@le.ac.uk.
Insights
Optical coherence tomography (OCT) successfully imaged infant dural vasculature, revealing numerous small blood vessels. This technique aids understanding of subdural haemorrhage (SDH) in abusive head trauma cases.
Area of Science:
- Neurology
- Medical Imaging
- Forensic Pathology
Background:
- Subdural haemorrhage (SDH) in infants is often linked to abusive head trauma.
- The source of bleeding is debated, with theories including bridging veins and dural vascular plexus.
- Conventional post-mortem and imaging methods have limitations in visualizing small dural vessels.
Purpose of the Study:
- To trial intravascular and benchtop optical coherence tomography (OCT) for imaging infant dural vasculature.
- To investigate the source of bleeding in infant subdural haemorrhage (SDH).
- To assess the potential of OCT for high-resolution 3D reconstruction of infant dural vessels.
Main Methods:
- Utilized intravascular and benchtop OCT systems during five infant/perinatal autopsies.
- Performed imaging from within the superior sagittal sinus (SSS) and through the dura mater.
- Measured diameters of identified blood vessels.
Main Results:
- Numerous vessel-like structures were identified using both OCT systems.
- Median diameters of vessels entering the SSS ranged from 110–125 μm.
- Median diameters of vessels near the SSS wall ranged from 80–90 μm.
Conclusions:
- OCT is a promising tool for detailed characterization of infant dural vasculature.
- Understanding dural vascular anatomy is crucial for elucidating the source of SDH.
- Further OCT development may enable high-resolution 3D reconstructions of infant dural vessels.
Abstract:
Infants and young children are likely to present with subdural haemorrhage (SDH) if they are the victims of abusive head trauma. In these cases, the most accepted theory for the source of bleeding is the bridging veins traversing from the surface of the brain to the dura mater. However, some have suggested that SDH may result from leakage of blood from a dural vascular plexus. As post-mortem examination of the bridging veins and dura is challenging, and imaging modalities such as magnetic resonance and computed tomography do not have the resolution capabilities to image small blood vessels, we have trialled the use of intravascular and benchtop optical coherence tomography (OCT) systems for imaging from within the superior sagittal sinus (SSS) and through the dura during five infant/perinatal autopsies. Numerous vessel-like structures were identified using both OCT systems. Measurements taken with the intravascular rotational system indicate that the approximate median diameters of blood vessels entering anterior and posterior segments of the SSS were 110 μm (range 70 to 670 μm, n = 21) and 125 μm (range 70 to 740 μm, n = 23), respectively. For blood vessels close to the wall of the SSS, the median diameters for anterior and posterior segments of the SSS were 80 μm (range 40 to 170 μm, n = 25) and 90 μm (range 30 to 150 μm), respectively. Detailed characterisation of the dural vasculature is important to aid understanding of the source of SDH. High resolution 3-dimensional reconstructions of the infant dural vasculature may be possible with further development of OCT systems.
