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Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado

2010, Number 4

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Rev Esp Med Quir 2010; 15 (4)

Usefulness of Doppler ultrasound in the surgical treatment of brain aneurysms

Valderrama FJA, Zárate MA, Hernández SM, Ortiz MCG, Martínez SB, Luján GJC, Lucino CJ

Language: Spanish
References: 21
Page: 189-195
PDF size: 88.89 Kb.


ABSTRACT

Background: Brain aneurysms are a relatively common entity; it is a complex pathology in the diagnosis and the treatment. The technique of microvascular Doppler ultrasound diagnosis during surgery as an assistant, with measurement of flows in real time, is helpful to optimize the aneurysms clipping.
Objective: To demonstrate the utility of Doppler ultrasound as an assistant in clipping cerebral aneurysms in the National Medical Center 20 de Noviembre of Mexico.
Patients and method: We performed ultrasonographic study in 18 patients with cerebral aneurysm of the National Medical Center 20 de Noviembre, ISSSTE, from July to December 2008. Transcraneal Doppler ultrasound in the 24 hours of internment; microvascular Doppler ultrasound during the surgical procedure, assessing vascular flow in aneurysm dome, proximal and distal arteries and adjacent arteries to the aneurysm, recording flows before and after placement of the clip on the neck of the aneurysm and 24 hours after clipping.
Results: 72.1% with complete successful clipping (no flow on the aneurysm dome and neck with distal blood flow unchanged and adjacent arteries without changes in their flows). 3 patients (16.6%) with optimal positioning of the clip in the second attempt. 100% with no aneurysm in the postoperatory cerebral angiography.
Conclusions: Microvascular transurgical Doppler ultrasound in patients clipping aneurysm is a method of auxiliary diagnostic, noninvasive, with high sensitivity and specificity that allows real-time verify the proper placement of the clip on the neck of the aneurysm, thus reducing complications.


REFERENCES

  1. Bilguvar K, Yasuno K, Niemela M, Ruigrok Y, et al. Susceptibility loci for intracranial aneurysm in European and Japanese populations. Nat Genet advanced online publication (November 9, 2008). doi:10.1038/ng.240. http://dx.doi.org/10.1038/ng.240

  2. Bonita R. Cigarrette smoking, hypertension and risk of subarachnoid hemorrhage. A population-base case-control study. Stroke 1986:17:831-835.

  3. Bromberg JEC, Rinkel GJE, Algra A, Limburg M, van Gijn J. Outcome in familial subarachnoid hemorrhage. Stroke 1995;26:961-963.

  4. Canbrao A, Pinto A, Ferro H, et al. Smoking and aneurysmal subarachnoid hemorrhage: A case–control study. J Cardiovasc Risk 1994;1:155-158.

  5. Davis G, Swalwel C. The incidence of acute cocaine or methamphetamine intoxication in deaths due to ruptured cerebral (berry) aneurysms. J Forensic Sci 1996;41:626-628.

  6. Juvela S, Hillborn M, Numminen H, Koskinen P. Cigarette smoking and alcohol consumption as risk factors for aneurysmal subarachnoid hemorrhage. Stroke 1993;24:639-646.

  7. Ljunggren B, Sharma S, Buchfelder M. History of aneurysm surgery. In: Racheson R, Wirth F, editors. Concepts in Neurosurgery. Baltimore: Williams and Wilkins, 1994;p:1-11.

  8. Silvestrini M, Troisi E, Razzano C, Caltagirone C. Correlations of flow velocity changes during mental activity and recovery from aphasia in ischemic stroke. Neurology 1998;50:191-195.

  9. Cuadrado ML, González JL, Egido JA, et al. Activation of the damaged hemisphere in poststroke recovery. A longitudinal study. 3th Congress of the Federation of Neurological Sciences, Sevilla, September, 1998.

  10. Bassi P, Bandera R, Loiero M, Tognoni G, Mangoni A. Warning signs in subarachnoid hemorrhage. A cooperative Study. Acta Neurol Scand 1991;84:277-281.

  11. Assessment: transcranial Doppler. Report of the American Academy of Neurology, Therapeutics and Technology Assessment Subcommittee. Neurology 1990;40(4):680-681.

  12. Rorick MB, Nichols FT, Adams RJ. Transcranial Doppler correlation with angiography in detection of intracranial stenosis. Stroke 1994;25:1931-1934.

  13. Tettenborn B, Estol C, DeWitt D, et al. Accuracy of transcranial Doppler in the vertebrobasilar circulation. J Neurol 1990;237:159.

  14. Serena J, Segura T, Perez-Ayuso MJ, Bassaganyas J, et al. The need to quantify right-to-left shunt in acute ischemic stroke. A case-control study. Stroke 1998;29:1322-1328.

  15. Ley-Pozo J, Ringelstein EB. Noninvasive detection of occlusive disease of the carotid siphon and MCA. Ann Neurol 1990;28:640-647.

  16. Muller M, Hermes M, Brückmann H, Schimrigk K. Transcranial Doppler ultrasound in the evaluation of collateral blood flow in patients with internal carotid artery occlusion: correlation with cerebral angiography. Am J Neurorad 1995;16:195-202.

  17. Petty GW, Mohr JP, Pedley TA, Tatemichi TK, et al. The role of transcranial Doppler in confirming brain death: sensibility, specificity and suggestions for performance and interpretation. Neurology 1990;40:300-303.

  18. Egido JA, Castrillo C, Sanchez M, Rabano J. Takayasu’s arteritis: transcranial Doppler findings and follow-up. J Neurosurg Sci 1996;40:121-124.

  19. Assistance of intraoperative microvascular Doppler in the surgical obliteration of spinal dural arteriovenous fistula: cases description and technical considerations. Neurosurgical Clinic, University of Messina School of Medicine, Messina, Italy. Discussion 137, 2003;145(2):133-137.

  20. Stendel R, Pietila T, Al Hassan AA, Schilling A, Brock M. Intraoperative microvascular Doppler ultrasonographic in cerebral aneurysm surgery. J Neurol Neurosurg Psychiatry 2000;68(1):29-35.

  21. Knecht S, Deppe M, Ebner A, Henningsen H, et al. Noninvasive determination of language lateralization by functional transcranial Doppler sonography. A comparison with the Wada test. Stroke 1998;29:82-86.




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