Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery
| Autor: | R. Stendel, T. Pietilä, Mario Brock, A. Schilling, Ali Abo al Hassan |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male medicine.medical_specialty Infarction Intraoperative Period Aneurysm medicine.artery Occlusion medicine Anterior cerebral artery Humans cardiovascular diseases Aged Aged 80 and over medicine.diagnostic_test Vascular disease business.industry Microcirculation Intracranial Aneurysm Ultrasonography Doppler Middle Aged medicine.disease Surgery Psychiatry and Mental health Stenosis Middle cerebral artery Angiography Papers cardiovascular system Female Neurology (clinical) Radiology business |
| Popis: | OBJECTIVES—Outcome of surgical treatment of cerebral aneurysms may be severely compromised by local cerebral ischaemia or infarction resulting from the inadvertent occlusion of an adjacent vessel by the aneurysm clip, or by incomplete aneurysm closure. It is therefore mandatory to optimise clip placement in situ to reduce the complication rate. The present study was performed to investigate the reliability of intraoperative microvascular Doppler ultrasonography (MDU) in cerebral aneurysm surgery, and to assess the impact of this method on the surgical procedure itself. METHODS—Seventy five patients (19 men, 56 women, mean age 54.8 years, range 22-84 years) with 90 saccular cerebral aneurysms were evaluated. Blood flow velocities in the aneurysmal sac and in the adjacent vessels were determined by MDU before and after aneurysm clipping. The findings of MDU were analysed and compared with those of visual inspection of the surgical site and of postoperative angiography. Analysis was also made of the cases in which the clip was repositioned due to MDU findings. RESULTS—A relevant stenosis of an adjacent vessel induced by clip positioning that had escaped detection by visual inspection was identified by Doppler ultrasonography in 17 out of 90 (18.9%) aneurysms. In addition, Doppler ultrasound demonstrated a primarily unoccluded aneurysm in 11 out of 90 (12.2%) patients. The aneurysm clip was repositioned on the basis of the MDU findings in 26 out of 90 (28.8%) cases. In middle cerebral artery (MCA) aneurysms, the MDU results were relevant to the surgical procedure in 17out of 44 (38.6%) cases. Whereas with aneurysms of the anterior cerebral artery significant findings occurred in only five of 32cases (15.6%; p |
| Databáze: | OpenAIRE |
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