Gulino Vincenzo, Brunasso Lara, Avallone Chiara, Campisi Benedetta Maria, Bonosi Lapo, Costanzo Roberta, Cammarata Emanuele, Sturiale Carmelo Lucio, Cordova Adriana, Iacopino Domenico Gerardo, Maugeri Rosario
Neurosurgical Clinic AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy.
Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy.
Brain Sci. 2024 Jan 6;14(1):56. doi: 10.3390/brainsci14010056.
Surgical treatment of neurovascular lesions like intracranial aneurysms, arteriovenous malformations and arteriovenous dural fistulas is still associated with high morbidity. Several recent studies are providing increasing insights into reliable tools to improve surgery and reduce complications. Inadvertent vessel compromise and incomplete occlusion of the lesion represent the most possible complications in neurovascular surgery. It is clear that direct visual examination alone does not allow to identify all instances of vessel compromise. Various modalities, including angiography, microvascular Doppler and neurophysiological studies, have been utilized for hemodynamics of flow vessels in proper clipping of the aneurysm or complete obliteration of the lesion. We intended to review the current knowledge about the intraoperative microvascular Doppler (iMDS) employment in the most updated literature, and explore the most recent implications not only in intracranial aneurysms but also in neurovascular lesions like arteriovenous malformations (AVMs) and arteriovenous dural fistulas (AVDFs). According to the PRISMA guidelines, systematic research in the most updated platform was performed in order to provide a complete overview about iMDS employment in neurovascular surgery. Twelve articles were included in the present paper and analyzed according to specific research areas. iMDS employment could represent a crucial tool to improve surgery in neurovascular lesions. The safety and effectiveness of the surgical treatment of neurovascular lesions like intracranial aneurysm and other neurovascular lesions like AVMs and AVDFs requires careful and accurate consideration regarding the assessment of anatomy and blood flow. Prognosis may depend on suboptimal or incomplete exclusion of the lesion.
颅内动脉瘤、动静脉畸形和动静脉硬脑膜瘘等神经血管病变的外科治疗仍具有较高的发病率。最近的几项研究对改善手术和减少并发症的可靠工具提供了越来越多的见解。术中意外的血管损伤和病变的不完全闭塞是神经血管手术中最可能出现的并发症。显然，仅靠直接的视觉检查无法识别所有血管损伤的情况。包括血管造影、微血管多普勒和神经生理学研究在内的各种方法已被用于在正确夹闭动脉瘤或完全消除病变时对血流血管的血流动力学进行评估。我们旨在回顾最新文献中关于术中微血管多普勒（iMDS）应用的现有知识，并探讨其最新意义，不仅涉及颅内动脉瘤，还涉及动静脉畸形（AVM）和动静脉硬脑膜瘘（AVDF）等神经血管病变。根据PRISMA指南，在最新平台上进行了系统研究，以便全面概述iMDS在神经血管手术中的应用。本文纳入了12篇文章，并根据特定研究领域进行了分析。iMDS的应用可能是改善神经血管病变手术的关键工具。颅内动脉瘤等神经血管病变以及AVM和AVDF等其他神经血管病变的外科治疗的安全性和有效性需要在评估解剖结构和血流时进行仔细而准确的考量。预后可能取决于病变排除不充分或不完全。
