Amin-Hanjani Sepideh, Meglio Guido, Gatto Rodolfo, Bauer Andrew, Charbel Fady T
Neuropsychiatric Institute (MC 799), Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 60612-5970, USA.
Neurosurgery. 2006 Apr;58(4 Suppl 2):ONS-305-12; discussion ONS-312. doi: 10.1227/01.NEU.0000209339.47929.34.
Inadvertent vessel compromise is one major cause of unfavorable outcome from aneurysm surgery. Existing strategies for intraoperative assessment of this complication have potential limitations and disadvantages. We assessed the utility of quantitative intraoperative flow measurements using the Transonic ultrasonic flow probe (Transonic Systems, Inc., Ithaca, NY) during aneurysm surgery.
Of all aneurysms treated surgically at our institution from 1998 to 2003, 103 patients with 106 aneurysms were identified in whom intraoperative flow measurements were available for analysis. We assessed the frequency of flow compromise and clip repositioning and correlated these with postoperative angiography and stroke.
Significant (>25%) reduction in flow rate was apparent in 33 (31.1%) cases, and resulted in clip repositioning in 27 (25.5%), with return to baseline flow except for two cases with vessel thrombosis/dissection. In the other six cases, flow reduction was owing to spasm resolving with papaverine (n = 3) or responded to retractor repositioning (n = 3). In another six (5.7%) cases, unnecessary clip repositioning was avoided (n = 3) or safe occlusion of the parent vessel for trapping of the aneurysm was allowed by confirming adequate distal flow (n = 3). Aneurysms of the basilar, middle cerebral, anterior communicating, or carotid terminus were more likely to be associated with flow compromise (odds ratio, 4.3; P = 0.03). Postoperative angiography corroborated vessel patency in all cases, and no unexpected large vessel occlusions or strokes were evident.
Use of the ultrasonic flow probe provides real-time immediate feedback concerning vessel patency. Vessel compromise is easier to interpret than with Doppler, and faster/less invasive than intraoperative angiography. Intraoperative flow measurement is a valuable adjunct for enhancing the safety of aneurysm surgery.
术中意外的血管损伤是动脉瘤手术不良预后的一个主要原因。现有的术中评估该并发症的策略存在潜在的局限性和缺点。我们评估了在动脉瘤手术中使用Transonic超声血流探头（Transonic Systems公司，纽约州伊萨卡）进行术中定量血流测量的效用。
在1998年至2003年期间在我们机构接受手术治疗的所有动脉瘤中，确定了103例患者的106个动脉瘤，术中血流测量数据可供分析。我们评估了血流受损和夹闭重新定位的频率，并将这些与术后血管造影和卒中情况相关联。
33例（31.1%）出现明显的血流速度显著降低（>25%），其中27例（25.5%）导致夹闭重新定位，除2例血管血栓形成/夹层外，血流恢复至基线水平。在另外6例中，血流减少是由于罂粟碱使痉挛缓解（n = 3）或牵开器重新定位后血流恢复（n = 3）。在另外6例（5.7%）中，避免了不必要的夹闭重新定位（n = 3）或通过确认足够的远端血流允许安全夹闭载瘤血管以夹闭动脉瘤（n = 3）。基底动脉、大脑中动脉、前交通动脉或颈内动脉末端的动脉瘤更有可能与血流受损相关（优势比，4.3；P = 0.03）。术后血管造影证实所有病例血管通畅，未发现意外的大血管闭塞或卒中。
使用超声血流探头可提供关于血管通畅情况的实时即时反馈。与多普勒相比，血管损伤情况更易于解读，且比术中血管造影更快/侵入性更小。术中血流测量是提高动脉瘤手术安全性的一项有价值的辅助手段。
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