Chadduck W M
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock.
J Child Neurol. 1989;4 Suppl:S91-100. doi: 10.1177/0883073889004001s14.
Experience using intraoperative real-time sonographic examinations for over a thousand patients has delineated the advantages of this surgical adjunct for a number of cranial and spinal pediatric neurosurgical procedures. Unusual and unfamiliar angles of insonation call for careful attention to anatomy. The advantages of intraoperative sonography in localizing intracerebral tumors, brain abscesses, and foreign bodies are demonstrated. In addition, adequacy of tumor removal can be assessed better at the time of operation and the operative area can be inspected for bleeding even after dural closure. In the pediatric age group, intraoperative real-time sonography is used most commonly for placement of shunts, allowing positioning of the ventricular catheter tip away from the choroid plexus. The use of air as a contrast agent in conjunction with intraoperative sonography allows better identification of catheter tips and can demonstrate the intercommunication of potentially isolated cavities within the brain. Intraoperative sonography has been extremely helpful, especially for identifying cysts within and the extent of intramedullary spinal cord tumors. Visualization of a syrinx is exquisite. Some of the cases presented also serve to identify limitations of intraoperative sonography as a surgical adjunct.
对一千多名患者进行术中实时超声检查的经验，已阐明了这种手术辅助手段在一些小儿颅脑和脊柱神经外科手术中的优势。不寻常和不熟悉的超声探测角度需要仔细关注解剖结构。术中超声在定位脑内肿瘤、脑脓肿和异物方面的优势得到了证明。此外，在手术时可以更好地评估肿瘤切除的充分性，甚至在硬脑膜闭合后也可以检查手术区域是否出血。在小儿年龄组中，术中实时超声最常用于分流管置入，使脑室导管尖端远离脉络丛定位。将空气作为造影剂与术中超声结合使用，可以更好地识别导管尖端，并能显示脑内潜在孤立腔隙的相互连通情况。术中超声非常有用，特别是对于识别脊髓髓内肿瘤内的囊肿及其范围。对脊髓空洞症的可视化非常清晰。所呈现的一些病例也有助于识别术中超声作为手术辅助手段的局限性。
