Busch Kathryn J, Kiat Hosen, Stephen Michael, Simons Mary, Avolio Alberto, Morgan Michael Kerin
Faculty of Medicine and Health Sciences, Suite 202, 2 Technology Place, Macquarie University, NSW 2109, Australia.
Faculty of Medicine and Health Sciences, Suite 202, 2 Technology Place, Macquarie University, NSW 2109, Australia.
J Clin Neurosci. 2016 Aug;30:24-30. doi: 10.1016/j.jocn.2016.01.029. Epub 2016 May 10.
Dramatic hemodynamic changes occur following resection of brain arteriovenous malformations (AVM). Transcranial Doppler (TCD) records non-invasive velocity and pulsatility parameters. We undertook a systematic review to assess AVM hemodynamics including the time course of changes in velocity and pulsatility in patients undergoing AVM resection. The review employed the Embase and Medline databases. A search strategy was designed. An initial title search for clinical series on AVM and TCD was performed followed by a search for reports on AVM and TCD. A total of 283 publications were selected. Full text analysis produced 54 studies with extractable data regarding AVM, velocity and pulsatility. Two TCD techniques were utilized: conventional "blind" TCD (blind TCD); and transcranial color duplex Doppler (TCCD). Of these, 23 publications reported on blind TCD and seven on TCCD. The presence of high velocity and low pulsatility within AVM feeding arteries preoperatively followed by a postoperative decrease in velocity and subsequent increase in pulsatility of feeding arteries is established. The time sequence of hemodynamic changes following AVM resection using TCD remains uncertain, confounded by variations in methodology and timing of perioperative measurements. Of the two techniques, TCCD reported qualitative aspects including improved differentiation of feeding arteries from draining veins. However, there are a limited number of studies supporting this conclusion. Furthermore, none report reproducible changes with time from treatment. TCCD appears to be a useful technique to analyze the hemodynamic changes occurring following treatment of AVM, however little data is available. This is a field of research that is appropriate to pursue.
脑动静脉畸形（AVM）切除术后会发生显著的血流动力学变化。经颅多普勒（TCD）可记录无创速度和搏动参数。我们进行了一项系统评价，以评估AVM血流动力学，包括AVM切除患者速度和搏动变化的时间进程。该评价采用了Embase和Medline数据库。设计了检索策略。首先对关于AVM和TCD的临床系列进行标题检索，随后检索关于AVM和TCD的报告。共筛选出283篇出版物。全文分析得到54项有关AVM、速度和搏动的可提取数据的研究。使用了两种TCD技术：传统的“盲法”TCD（盲法TCD）；以及经颅彩色双功多普勒（TCCD）。其中，23篇出版物报道了盲法TCD，7篇报道了TCCD。术前AVM供血动脉内存在高速和低搏动，术后供血动脉速度下降，随后搏动增加，这一点已得到证实。使用TCD评估AVM切除术后血流动力学变化的时间顺序仍不确定，这受到围手术期测量方法和时间变化的影响。在这两种技术中，TCCD报告了定性方面，包括改善了供血动脉与引流静脉的区分。然而，支持这一结论的研究数量有限。此外，没有研究报告随治疗时间的可重复变化。TCCD似乎是一种分析AVM治疗后血流动力学变化的有用技术，然而可用数据很少。这是一个值得探索的研究领域。
