Cui Hua, Wang Yong, Yin Yuhua, Wan Jieqing, Fei Zhimin, Gao Weizhen, Jiang Jiyao
Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200001, People's Republic of China.
J Clin Ultrasound. 2011 Jan;39(1):27-31. doi: 10.1002/jcu.20751. Epub 2010 Oct 14.
The outcome of surgical treatment of intracranial aneurysms may be influenced by incomplete exclusion of the aneurysm or stenosis of the parent vessels. The goal of this study was to evaluate the usefulness and reliability of intraoperative microvascular Doppler (IMD) in guiding optimal clip placement in aneurysm surgery.
We conducted a retrospective analysis of 79 patients, with a total of 85 intracranial aneurysms, operated between January 2004 and April 2009, who were evaluated with IMD using a 20-MHz probe before and after clip application. IMD was used to examine the aneurysmal sac and adjacent vessels.
The findings of IMD helped in adjusting the clip placement. In 9 (10.6%) of the 85 aneurysms, IMD revealed a persistent blood flow through the aneurysmal sac after clip application and the clip was repositioned. IMD showed relevant stenosis of adjacent vessels induced by the clip positioning in 10 of 79 (12.7%) cases. In six cases (7.6%), a blood flow reduction in the artery feeding the aneurysm was evident after clipping; in the other four cases (5.1%), the clip produced a severe blood flow reduction in other adjacent vessels. In addition, in two of these cases, an initial stenosis induced by clip positioning that had escaped detection by visual inspection through the operating microscope was identified by IMD. There were no complications related to the use of IMD.
IMD is a safe, feasible, and very reliable technique and should be used routinely in intracranial aneurysm surgery.
颅内动脉瘤手术治疗的结果可能会受到动脉瘤未完全夹闭或载瘤血管狭窄的影响。本研究的目的是评估术中微血管多普勒（IMD）在指导动脉瘤手术中最佳夹闭位置放置方面的实用性和可靠性。
我们对2004年1月至2009年4月间接受手术的79例患者（共85个颅内动脉瘤）进行了回顾性分析，这些患者在夹闭前后使用20兆赫探头进行了IMD评估。IMD用于检查动脉瘤囊和相邻血管。
IMD的检查结果有助于调整夹闭位置。在85个动脉瘤中的9个（10.6%）中，IMD显示夹闭后动脉瘤囊内仍有持续血流，于是重新调整了夹子位置。IMD显示在79例中的10例（12.7%）中，夹闭位置导致相邻血管出现相关狭窄。在6例（7.6%）中，夹闭后向动脉瘤供血的动脉血流明显减少；在另外4例（5.1%）中，夹子导致其他相邻血管出现严重血流减少。此外，在其中2例中，IMD发现了最初因夹闭位置导致的狭窄，而通过手术显微镜目视检查未发现该狭窄。未出现与使用IMD相关的并发症。
IMD是一种安全、可行且非常可靠的技术，应在颅内动脉瘤手术中常规使用。
