目的探讨在治疗脑积水的内镜三脑室底造瘘术(endoscopic third ventriculostomy ETV)中,应用多普勒微血管探头作超声扫描检查的意义。方法单纯神经内镜下完成梗阻性脑积水ETV 34例,其中21例应用多普勒微血管探头经内镜通道抵达三脑室底...目的探讨在治疗脑积水的内镜三脑室底造瘘术(endoscopic third ventriculostomy ETV)中,应用多普勒微血管探头作超声扫描检查的意义。方法单纯神经内镜下完成梗阻性脑积水ETV 34例,其中21例应用多普勒微血管探头经内镜通道抵达三脑室底部进行超声探测,监测基底动脉的走向、血流速度,进行术中实时定位,造瘘前后记录血管的多普勒超声图像。结果21例造瘘术前后BA的管径、血流速度无变化,无血管损伤并发症。术后21例(61.76%)影像学证实扩大的脑室术后有回缩;半年后症状缓解29例(85.29%),5例无效(14.71%),2例做脑室腹腔分流术。无手术死亡或残疾。结论多普勒微血管探头在ETV中加以应用,可减少血管损伤类并发症的发生,使得内镜插入定位精确,安全。展开更多
Background Surgical treatment of intracranial aneurysms is often compromised by incomplete exclusion of the aneurysm or stenosis of parent vessels. Intraoperative microvascular Doppler （IMD） is an attractive, noninv...Background Surgical treatment of intracranial aneurysms is often compromised by incomplete exclusion of the aneurysm or stenosis of parent vessels. Intraoperative microvascular Doppler （IMD） is an attractive, noninvasive, and inexpensive tool. The present study aimed to evaluate the usefulness and reliability of IMD for guiding clip placement in aneurysm surgery. Methods A total of 92 patients with 101 intracranial aneurysms were included in the study. IMD with a 1.5-mm diameter, 20-MHz microprobe was used before and after clip application to confirm aneurysm obliteration and patency of parent vessels and branching arteries. IMD findings were verified postoperatively with digital subtraction angiography （DSA） or dual energy computed tomography angiography （DE-CTA）. Ninety consecutive patients, harboring 108 aneurysms, who underwent surgery without IMD was considered as the control group. Results The microprobe detected all vessels of the Circle of Willis and their major branches. Clips were repositioned in 24 （23.8%） aneurysms on the basis of the IMD findings consistent with incomplete exclusion and/or stenosis. IMD identified persistent weak blood flow through the aneurismal sac of 11 of the 101 （10.9%） aneurysms requiring clip adjustment. Stenosis or occlusion of the parent or branching arteries as indicated by IMD necessitated immediate clip adjustment in 19 aneurysms （18.8%）. The mean duration of the IMD procedure was 4.8 minutes. The frequency of clip adjustment （mean： 1.8 times per case） was associated with the size and location of the aneurysm. There were no complications related to the use of IMD, and postoperative angiograms confirmed complete aneurysm exclusion and parent vessel patency. About 8.3% （9/108） aneurysms were unexpectedly incompletely occluded, and 10.2% （11/108） aneurysms and parent vessel stenosis without IMD were detected by postoperative DSA or DE-CTA. IMD could reduce the rate of residual aneurysm and unanticipated vessel stenosis which demonstrated展开更多
目的探讨多种辅助监测技术——微血管多普勒超声(microvascular doppler ultrasonography,MDU)和吲哚菁绿荧光造影(indocyanine green angiography,ICGA)在复杂颅内动脉瘤开颅手术中的应用价值。方法回顾分析2019-01—2020-12在徐州医...目的探讨多种辅助监测技术——微血管多普勒超声(microvascular doppler ultrasonography,MDU)和吲哚菁绿荧光造影(indocyanine green angiography,ICGA)在复杂颅内动脉瘤开颅手术中的应用价值。方法回顾分析2019-01—2020-12在徐州医科大学附属医院脑血管外科行开颅夹闭的30例复杂颅内动脉瘤患者的临床资料,术中均采用MDU及ICGA对载瘤血管及分支血管进行监测。结果术中MDU监测发现夹闭瘤颈后,载瘤动脉血流及分支血管异常3例,瘤颈夹闭不全1例,术中ICGA图像清晰,其中3例载瘤动脉及4例分支血管狭窄,经及时调整动脉瘤夹后无载瘤动脉狭窄,瘤颈夹闭完全,载瘤动脉显影良好。术后复查头颅CTA或DSA,与术中MDU、荧光造影结果一致。结论术中微血管多普勒超声联合吲哚菁绿荧光造影可无创、反复、准确地判断血管的形态及通畅性,值得在复杂颅内动脉瘤开颅夹闭术中推广。展开更多
文摘目的探讨在治疗脑积水的内镜三脑室底造瘘术(endoscopic third ventriculostomy ETV)中,应用多普勒微血管探头作超声扫描检查的意义。方法单纯神经内镜下完成梗阻性脑积水ETV 34例,其中21例应用多普勒微血管探头经内镜通道抵达三脑室底部进行超声探测,监测基底动脉的走向、血流速度,进行术中实时定位,造瘘前后记录血管的多普勒超声图像。结果21例造瘘术前后BA的管径、血流速度无变化,无血管损伤并发症。术后21例(61.76%)影像学证实扩大的脑室术后有回缩;半年后症状缓解29例(85.29%),5例无效(14.71%),2例做脑室腹腔分流术。无手术死亡或残疾。结论多普勒微血管探头在ETV中加以应用,可减少血管损伤类并发症的发生,使得内镜插入定位精确,安全。
文摘Background Surgical treatment of intracranial aneurysms is often compromised by incomplete exclusion of the aneurysm or stenosis of parent vessels. Intraoperative microvascular Doppler （IMD） is an attractive, noninvasive, and inexpensive tool. The present study aimed to evaluate the usefulness and reliability of IMD for guiding clip placement in aneurysm surgery. Methods A total of 92 patients with 101 intracranial aneurysms were included in the study. IMD with a 1.5-mm diameter, 20-MHz microprobe was used before and after clip application to confirm aneurysm obliteration and patency of parent vessels and branching arteries. IMD findings were verified postoperatively with digital subtraction angiography （DSA） or dual energy computed tomography angiography （DE-CTA）. Ninety consecutive patients, harboring 108 aneurysms, who underwent surgery without IMD was considered as the control group. Results The microprobe detected all vessels of the Circle of Willis and their major branches. Clips were repositioned in 24 （23.8%） aneurysms on the basis of the IMD findings consistent with incomplete exclusion and/or stenosis. IMD identified persistent weak blood flow through the aneurismal sac of 11 of the 101 （10.9%） aneurysms requiring clip adjustment. Stenosis or occlusion of the parent or branching arteries as indicated by IMD necessitated immediate clip adjustment in 19 aneurysms （18.8%）. The mean duration of the IMD procedure was 4.8 minutes. The frequency of clip adjustment （mean： 1.8 times per case） was associated with the size and location of the aneurysm. There were no complications related to the use of IMD, and postoperative angiograms confirmed complete aneurysm exclusion and parent vessel patency. About 8.3% （9/108） aneurysms were unexpectedly incompletely occluded, and 10.2% （11/108） aneurysms and parent vessel stenosis without IMD were detected by postoperative DSA or DE-CTA. IMD could reduce the rate of residual aneurysm and unanticipated vessel stenosis which demonstrated
文摘目的探讨多种辅助监测技术——微血管多普勒超声(microvascular doppler ultrasonography,MDU)和吲哚菁绿荧光造影(indocyanine green angiography,ICGA)在复杂颅内动脉瘤开颅手术中的应用价值。方法回顾分析2019-01—2020-12在徐州医科大学附属医院脑血管外科行开颅夹闭的30例复杂颅内动脉瘤患者的临床资料,术中均采用MDU及ICGA对载瘤血管及分支血管进行监测。结果术中MDU监测发现夹闭瘤颈后,载瘤动脉血流及分支血管异常3例,瘤颈夹闭不全1例,术中ICGA图像清晰,其中3例载瘤动脉及4例分支血管狭窄,经及时调整动脉瘤夹后无载瘤动脉狭窄,瘤颈夹闭完全,载瘤动脉显影良好。术后复查头颅CTA或DSA,与术中MDU、荧光造影结果一致。结论术中微血管多普勒超声联合吲哚菁绿荧光造影可无创、反复、准确地判断血管的形态及通畅性,值得在复杂颅内动脉瘤开颅夹闭术中推广。
