Iwamoto N, Kusaka M, Tsurutani T, Kameda H, Ito H
Department of Neurosurgery, Yamaguchi University School of Medicine, Japan.
Stereotact Funct Neurosurg. 1993;60(4):194-204. doi: 10.1159/000100608.
Stereotactic aqua-stream and aspiration (SASA) has been used for the evacuation of intracerebral hematomas. The authors have introduced ultrasound imaging (US) to monitor the evacuations of the hematoma during the surgical procedure. Hematomas were reproduced in an agar hematoma model which showed that if air collected in the hematoma cavity, it produced a strong artifact, and the hematoma could not be monitored. In the clinical trial, hematomas were visualized, and the surgical procedures were monitored in real time. The needle of the SASA and the air that collected in the hematoma cavity produced only weak artifacts, and the SASA water jet showed as a hyperechoic region on US, so that the procedure could be monitored in real time. In all cases, the average amount of evacuated hematoma exceeded 92%, as calculated from the preoperative and postoperative computed tomography images. The level of consciousness improved from a preoperative level of 1-20 (Japan Coma Scale) to 0-3 postoperatively. The addition of US monitoring to computed tomography guided stereotactic evacuation of hematomas with SASA enabled hypertension-associated intracranial hematomas to be evacuated more safely and more completely than has been achieved hitherto.
立体定向水射流与抽吸术（SASA）已被用于脑内血肿的清除。作者引入了超声成像（US）来在手术过程中监测血肿的清除情况。在琼脂血肿模型中重现血肿，结果显示如果血肿腔内积聚空气，会产生强烈伪像，从而无法监测血肿。在临床试验中，血肿得以可视化，手术过程也能实时监测。SASA的针以及血肿腔内积聚的空气仅产生微弱伪像，且SASA水射流在超声上显示为高回声区域，因此手术过程能够实时监测。在所有病例中，根据术前和术后计算机断层扫描图像计算，血肿的平均清除量超过92%。意识水平从术前的1 - 20（日本昏迷量表）改善至术后的0 - 3。在计算机断层扫描引导下，对SASA清除血肿术增加超声监测，使得高血压相关性颅内血肿能够比以往更安全、更彻底地被清除。
