1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
2Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia.
Neurosurg Focus. 2018 Jul;45(1):E6. doi: 10.3171/2018.4.FOCUS18101.
The relevance of the cerebral venous system is often underestimated during neurosurgical procedures. Damage to this draining system can have catastrophic implications for the patient. Surgical decision-making and planning must consider each component of the venous compartment, from the medullary draining vein to the dural sinuses and extracranial veins. Intraoperative ultrasound (ioUS) permits the real-time study of venous compartments using different modalities, thus allowing complete characterization of their anatomical and functional features. The B-mode (brightness mode) offers a high-resolution anatomical representation of veins and their relationships with lesions. Doppler modalities (color, power, spectral) allow the study of blood flow and identification of vessels to distinguish their functional characteristics. Contrast-enhanced US allows one to perform real-time angiosonography showing both the functional and the anatomical aspects of vessels. In this technical report, the authors demonstrate the different applications of multimodal ioUS in neurosurgery for identifying the anatomical and functional characteristics of the venous compartment. They discuss the general principles and technical nuances of ioUS and analyze their potential implications for the study of various venous districts during neurosurgical procedures.
在神经外科手术中，人们常常低估脑静脉系统的重要性。该引流系统的损伤可能给患者带来灾难性的后果。手术决策和规划必须考虑到静脉腔室的每个组成部分，从髓质引流静脉到硬脑膜窦和颅外静脉。术中超声（ioUS）允许使用不同模式实时研究静脉腔室，从而能够全面描述其解剖和功能特征。B 模式（亮度模式）提供了静脉及其与病变关系的高分辨率解剖学表示。多普勒模式（彩色、功率、频谱）允许研究血流并识别血管，以区分其功能特征。对比增强超声允许实时进行血管造影，显示血管的功能和解剖方面。在本技术报告中，作者展示了多模态 ioUS 在神经外科中用于识别静脉腔室解剖和功能特征的不同应用。他们讨论了 ioUS 的一般原则和技术细节，并分析了它们对神经外科手术中不同静脉区域研究的潜在影响。
