Impact of introduction of the vascular microdoppler for the evaluation of cerebral blood flow during microsurgery of intracranial aneurysms

Autor: Pereira, Benedito Jamilson Ara??jo
Přispěvatelé: Oliveira, Jean Gon??alves de, Aguiar, Paulo Henrique Pires de, Chavantes, Maria Cristina
Jazyk: portugalština
Rok vydání: 2013
Předmět:
Zdroj: Biblioteca Digital de Teses e Dissertações da Uninove
Universidade Nove de Julho (UNINOVE)
instacron:UNINOVE
Popis: Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-27T15:13:50Z No. of bitstreams: 1 Benedito Jamilson Araujo Pereira.pdf: 2332120 bytes, checksum: b715adc7f3a69ca8a5c81d5a6b38fa98 (MD5) Made available in DSpace on 2015-07-27T15:13:50Z (GMT). No. of bitstreams: 1 Benedito Jamilson Araujo Pereira.pdf: 2332120 bytes, checksum: b715adc7f3a69ca8a5c81d5a6b38fa98 (MD5) Previous issue date: 2013-12-18 In vascular microsurgery, the clipping of intracranial aneurysms may result in partial or complete occlusion of the parental artery, resulting in ischemic infarction. Methods that analyze cerebral blood flow during this procedure are essential to prevent those complications. The use of Ultrassom Doppler (USD) to assess vascular hemodynamics of vessels and aneurysms before and after clipping presents good results compared to the gold-standard technique, intraoperative angiography. Objective: To analyze the impact of the MD introduction, as a method of analysis of cerebral blood flow during microsurgery of intracranial aneurysms by checking the partial occlusion of the aneurysm and the occurrence of stenosis, comparing these results with those provided by the postoperative digital subtraction angiography (DSA), and the occurrence of ischemic infarction on the postoperative computerized tomography (CT) images. Patients and Methods: We reviewed retrospectively the last 50 patients operated on before the introduction of the MD compared to the first 50 patients operated on using this technique. All patients underwent pre and postoperative DSA to analyze the occurrence of residual aneurysms and the occlusion of parental arteries, as well as pre and postoperative CT to assess the incidence of ischemic infarction, postoperatively. Results: CT findings: 9 (18%) of the 50 patients evaluated in the group where the MD was not used showed hypodensity in the postoperative CT images, while only 2 patients showed infarction in the group in which the MD was used (p = 0.02). Regarding the postoperative angiography findings, the results were as follows: in the group in which the MD was not used, 10 patients presented unexpected findings (residual aneurysms, stenosis and arterial occlusion); whereas in the group in which the MD was used, those unexpected findings were observed in only 3 patients (p = 0.023). Conclusion: The MD was an excellent method for cerebral blood flow assessment during the microsurgery of intracranial aneurysms, reducing the unexpected angiographic results (residual aneurysms, stenosis and arterial occlusion), as well as reducing the incidence of ischemic infarction on postoperative CT images, when compared with the group where this method was not used, evidencing a positive impact of this method in the treatment of intracranial aneurysms. Durante a microcirurgia vascular para clipagem de aneurismas intracranianos pode ocorrer ?? oclus??o parcial ou completa da art??ria que origina o aneurisma e, consequentemente, infarto isqu??mico decorrente desta oclus??o inadvertida. M??todos que analisam o fluxo sangu??neo durante este tipo de cirurgia s??o fundamentais para evitar estas complica????es. A utiliza????o do Ultrassom-doppler (USD) vascular para avaliar a hemodin??mica dos vasos e aneurismas antes e ap??s a clipagem dos ??ltimos, apresenta bons resultados quando comparados ?? t??cnica padr??o-ouro que ?? a angiografia digital por subtra????o intra-operat??ria. Objetivo: Analisar o impacto da utiliza????o do USD como m??todo de an??lise do fluxo sangu??neo cerebral durante a microcirurgia dos aneurismas intracranianos, verificando a oclus??o parcial dos aneurismas e a ocorr??ncia de estenose, comparando estes resultados com os resultados da ADS p??s-operat??ria, ou oclus??o vascular inadvertida e isquemias p??s-operat??rias atrav??s de imagens de tomografia computadorizada. Casu??stica e M??todos: Foram analisados retrospectivamente os ??ltimos 50 pacientes operados antes da introdu????o do USD comparando com os resultados dos primeiros 50 aneurismas operados utilizando esta t??cnica. Todos os pacientes foram submetidos ?? ADS pr??- e p??s-operat??rias para a an??lise de aneurisma residual e oclus??o de art??rias, al??m de tomografia computadorizada de cr??nio para a an??lise de infarto isqu??mico p??s-operat??rio. Resultados: Em rela????o ??s altera????es tomogr??ficas, 9 (18%) dos 50 pacientes avaliados no grupo sem uso do USD, apresentaram hipodensidade nas imagens de tomografias p??s-operat??rias, ao passo que apenas 2 casos apresentaram estas altera????es no grupo em que o USD, foi utilizado (p=0,02). A angiografia p??s-operat??ria apresentou os seguintes resultados: no grupo em que o USD n??o foi utilizado, observamos resultados diferentes do normal em 10 pacientes, ao passo que no grupo em que o USD foi utilizado estas altera????es foram observadas em apenas 3 pacientes (p=0,023). Conclus??o: O USD se mostrou um excelente m??todo para a an??lise do fluxo sangu??neo cerebral durante a microcirurgia de aneurismas intracranianos, com redu????o de resultados angiogr??ficos sub??timos (aneurisma residual, estenose e oclus??o arterial), assim como redu????o de infarto isqu??mico na TC de cr??nio p??s-operat??ria, quando comparado com o grupo onde este m??todo n??o foi utilizado, evidenciando um impacto positivo deste m??todo no tratamento dos aneurismas intracranianos.
Databáze: OpenAIRE
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