Ciricillo S F, Schmidt K G, Silverman N H, Hieshima G B, Higashida R T, Halbach V V, Edwards M S
Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
Neurosurgery. 1990 Oct;27(4):544-8. doi: 10.1097/00006123-199010000-00007.
Two-dimensional echocardiography complemented with color-flow imaging and pulsed Doppler ultrasound was used to evaluate one fetus and five neonates with a vein of Galen malformation who had severe high-output congestive heart failure and cranial bruits at birth. Intracranial blood flow through the vein of Galen malformations, cardiac status, and direction of aortic blood flow were assessed before and after staged interventional neuroradiological treatment with transarterial and transvenous embolization procedures. Color-flow imaging in each infant displayed the major vascular anatomy including feeding vessels and the patterns of filling of the vein of Galen malformations. Pulsed Doppler ultrasound performed on the descending aorta above the diaphragm showed the degree of diastolic flow reversal indicative of runoff into the vein of Galen malformations. A reduction in blood flow through the vein of Galen malformation was seen on color-flow imaging in four patients treated successfully by embolic procedures. The ratio of diastolic retrograde flow velocity in the descending aorta to systolic antegrade velocity decreased from 0.51 +/- 0.15 (mean +/- standard deviation) to 0.15 +/- 0.20 (P less than 0.05). Color-flow imaging and pulsed Doppler ultrasonography provided anatomical and pathophysiological information regarding cardiac hemodynamics and intracranial blood flow; with the patient's clinical status, these methods provided a reliable, noninvasive means to evaluate the effectiveness of therapy and the need for further treatment in neonates with vein of Galen malformations.
采用二维超声心动图联合彩色血流成像和脉冲多普勒超声对1例胎儿及5例患有大脑大静脉畸形的新生儿进行评估，这些新生儿出生时均患有严重的高输出量充血性心力衰竭和颅内血管杂音。在采用经动脉和经静脉栓塞程序进行分期介入神经放射治疗前后，评估通过大脑大静脉畸形的颅内血流、心脏状况以及主动脉血流方向。对每个婴儿进行的彩色血流成像显示了主要的血管解剖结构，包括供血血管以及大脑大静脉畸形的充盈模式。在膈肌上方的降主动脉上进行的脉冲多普勒超声显示了舒张期血流逆转的程度，这表明有血液流入大脑大静脉畸形。在4例通过栓塞程序成功治疗的患者中，彩色血流成像显示通过大脑大静脉畸形的血流减少。降主动脉舒张期逆行血流速度与收缩期顺行血流速度之比从0.51±0.15（平均值±标准差）降至0.15±0.20（P<0.05）。彩色血流成像和脉冲多普勒超声提供了有关心脏血流动力学和颅内血流的解剖学和病理生理学信息；结合患者的临床状况，这些方法为评估患有大脑大静脉畸形的新生儿的治疗效果和进一步治疗需求提供了一种可靠的非侵入性手段。
