• Nitin Mukerji, Douglas J Cook, and Gary K Steinberg.
• Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
• World Neurosurg. 2015 Dec 1;84(6):2079.e1-5.

ObjectiveTo report 2 cases of patients who had an ischemic stroke and an intracerebral hematoma after a superficial temporal artery-middle cerebral artery bypass with a thermal diffusion blood flow probe in situ and emphasize how a change in the way the data are presented could have led to an earlier diagnosis.MethodsBoth patients had flow probes within 2 cm of the graft site and were thus close enough to be representative of local or regional rather than global perfusion. Data smoothening was applied to the raw data that were available and displayed on the monitor. Both the smoothed plots and the raw plots were analyzed.ResultsGood clinical correlation was observed between the flow probe data and the clinical condition of both patients. This was more apparent when viewing the smoothed plots.ConclusionsAlthough there was good clinical correlation, data displayed on the perfusion monitor can be incorrectly interpreted because the signal-to-noise ratio is small. We therefore suggest an alternative presentation of perfusion data for clinicians to recognize hypoperfusion and to take informed action before a stroke or hematoma is clinically manifest.Copyright © 2015 Elsevier Inc. All rights reserved.

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