Summary
Ultrasound Doppler sonography with miniaturized probes and high resolution offers new possibilities of intraoperative control of neurovascular procedures. Patency, flow direction stenoses and changes in resistance can be investigated atraumatically, repeatedly and without additional preparation.
In bypass and aneurysm surgery, about 10% of the cases were shown by Doppler examinations to be unsatisfactory, with stenoses and occlusions. These could be immediately corrected without loss of time. In normal cases, the information on the local haemodynamics enlarges the knowledge as to the effects of the operation and make it safer.
Real time ultrasonography, which can be easily adapted to neurosurgery, is a new atraumatic tool for localizing, in two dimensions, subcortical intrinsic processes, haematomas, ventricles ect. It is useful for guided biopsies and punctures and for the centering of the dura and brain incision over the middle of the lesion, especially in microsurgical procedures.
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References
Backlund, E.-O. et al.: Stereotactic exploration of brain tumours by ultrasound. From the departments of Neurosurgery and Neuroradiology Karolinska Sjukhuset, Stockholm (1973) 117–122
Carter, L. P., R. B. S. Erspamer, W. L. White et al.: Cortical blood flow during craniotomy for aneurysm. Surg. Neurol. 17 (1982) 204–208
Carter, L. P., R. J. Erspamer: Regional cortical blood flow during cerebrovascular surgery. In: Peerless, S. J., C. W. McCormick (eds.): Microsurgery for Cerebral Ischemia, 40–45. Springer, Berlin—Heidelberg—New York 1980
Cathignol, P., J. Y. Chapelon, C. Fourcade: Vélocimètre Doppler à l'usage des petits vaisseaux, le Microflo. Biosigma (Paris) (1978) 426–429
Cathignol, D., C. Fourcade: Improvement of pulsed Doppler flowmeter for use in microvascular diagnosis. ICEU New Delhi A 13 (1980) 18–20
Chantler, W. F. et al.: Intraoperative use of real-time ultrasonography in neurosurgery. J. Neurosurg. 57 (1982) 157–163
Chater, N.: Surgical results and measurements of intraoperative flow in microsurgical anastomoses. In: Austin, G. M., C. C. Thomas (eds.): Microsurgical Anastomoses for Cerebral Ischemia, 295–304. Ch. C. Thomas, Springfield, Ill. 1976
Collier, B. D. et al.: Ultrasound directed placement of needles into brains of Rhesus monkeys. Neuroradiology, 19 (1980) 201–205
Cook, J. H., B. Lytton: Intraoperative localization of renal calculus during nephrolithotomy by ultrasound scanning. J. Urol. 117 (1977) 543–546
Coulon, R. A. Jr., Ch. R. B. Merritt: Use of ultrasound in the insertion of intracranial shunts in infants. In: American Society for Pediatric Neurosurgery Concepts in Pediatric Neurosurgery 3, 216–219. S. Karger, Basel 1983
Dohrmann, G. J. and Rubin, J. M.: Use of ultrasound in neurosurgical operations: a preliminary report. Surgical Neurology 16 (1981) 362–366
Dyck, P. et al.: Intra-operative ultrasonic encephalography of cerebral mass lesions. Second Annual Meeting, Federation of Western Societies of Neurological Science, San Francisco, California, 114–124
Enzmann, D. R. et al.: Experimental study of highresolution ultrasound imaging of hemorrhage, bone fragments, and foreign bodies in head trauma. J. Neurosurg., 54 (1981) 304–309
Feindel, W., Y. L. Yamamoto, C. P. Hodge: Red cerebral veins and the cerebral steal syndrome. Evidence from fluorescein angiography and microregional blood flow by radioisotopes during excision of an angioma. J. Neurosurg. 35 (1971) 167–179
Ferguson, G. G.: Turbulence in human intracranial saccular aneurysms. J. Neurosurg. 33 (1970) 485–487
Freed, D., C. J. Hartley, K. D. Christman et al.: Highfrequency pulsed Doppler ultrasound: a new tool for microvascular surgery. J. Microsurg. 1 (1979) 148–153
Fürmaier, R., F. Staudt: Rekonstruktion coronarer und sagittaler Ebenen von CT-Bildern im Vergleich zur zweidimensionalen Echoenzephalographie bei Neugeborenen und Säuglingen. Fortschr. Röntgenstr. 137 (1982) 37–42
Gilsbach, J.: Intraoperative Doppler sonography in neurosurgery. Springer-Verlag, Wien 1983
Grode, M. L., M. S. Komaiko: The role of intraoperative ultrasound in neurosurgery. Neurosurgery 12 (1983) 624–628
Hartley, C. J., J. S. Cole: An ultrasonic pulsed Doppler system for measuring blood in small vessels. J. Appl. Physiol. 37 (1974) 626–629
Lange, S. C. et al.: Intraoperative ultrasound detection of metastatic tumours in the central cortex. Neurosurgery 11 (1982) 219–222
Little, J. R., Y. L. Yamamoto, W. Feindel et al.: Superficial temporal artery to middle cerebral artery anastomosis; intraoperative evaluation by fluorescein angiography and xenon-133 clearance. J. Neurosurg. 50 (1979) 560–569
Loop, J. W., E. L. Foltz: Applications of angiography during intracranial operations. Acta Radiol. (Diagn.) 5 (1966) 363–367
Moritake, K., H. Handa, Y. Yonekawa et al: Ultrasonic Doppler assessment of hemodynamics in superficial temporal artery-middle cerebral artery anastomosis. Surg. Neurol. 13 (1980) 249–257
Nornes, H., P. Wikeby: Cerebral arterial blood flow and aneurysm surgery. Part 1, local arterial flow dynamics. J. Neurosurg. 47 (1977) 810–818
Nornes, H., H. B. Knutzen, P. Wikeby: Cerebral arterial blood flow and aneurysm surgery. Part 2, Induced hypotension J. Neurosurg. 47 (1977) 819–827
Nornes, H., A. Grip, P. Wikeby: Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique. Part 1, Arteriovenous malformations. J. Neurosurg. 50 (1979) 145–151
Nornes, H., A. Grip, P. Wikeby: Intraoperative evaluation of cerebral haemodynamics using directional Doppler technique. Part 2, saccular aneurysms. J. Neurosurg. 50 (1979) 570–577
Parkinson, D.: Rapid serial simultaneous biplane stereoscopic angiography; an aid in the surgical management of cerebral arteriovenous malformations. Clin. Neurosurg. 16 (1969) 179–184
Parkinson, D., D. Legal, A. F. Holloway, et al.: A new combined neurosurgical headholder and cassette changer for intraoperative serial angiography. Technical note. J. Neurosurg. 48 (1978) 1038–1041
Pendl, G.: Two-dimensional ultrasound encephalography in infants and children. Neuropädiatrie 5 (1974) 5–7
Reid, M. H. et al.: Ultrasound applications in Neurosurgery. In: Neurological Surgery Vol. 2, Ed. J. R. Youmans, W. B. Sanders Comp. Philadelphia, London 1982
Roux, R. X. et al.: Utilisation de l'ultrasonographie en temps réel en neurochirurgie. Intérêt per-operative chez l'adulte. Neurochirurgie 29 (1983) 31–35
Rubin, J. M. et al.: Use of ultrasonically guided probes and catheters in Neurosurgery. Surg. Neurol. 18 (1982) 143–148
Shalit, M. N. et al.: Experience with intraoperative CT scanning in brain tumours. Surg. Neurol. 17 (1982) 376–383
Sjölander, U. et al.: Ultrasound sector scanning for the localization and biopsy of intracerebral lesions. J. Neurosurg. 58 (1983) 7–10
Spencer, M. P., J. M. Reid (eds.): Cerebrovascular Evaluation with Doppler Ultrasound. Martinus Nijhoff, The Hague — Boston — London 1981
Spetzler, R. F., H. Schuster, R. A. Roski: Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J. Neurosurg. 53 (1980) 22–27
Tanaka, K. et al.: The localization of brain tumours by ultrasonic techniques. A clinical review of 111 cases. J. Neurosurg. 23 (1965) 135–147
Tsutsumi, Y. et al.: Ultrasound-guided biopsy for deepseated brain tumours. J. Neurosurg. 57 (1982) 164–167
Valkeakair, T.: Erfahrungen mit zweidimensionaler Echo-Enzephalographie bei Kindern. In: Ultrasonographica Medica, Vol. 1, Ed.: Böck, J., K. Ossoing, 361. Verlag der Wiener Med. Akademie, 1971
Voorhies, R. M. et al.: Intraoperative localization of subcortical brain tumours: further experience with Bmode realtime sector scanning. Neurosurgery 12 (1983) 189–194
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Gilsbach, J.M., Hassler, W.E. Intraoperative doppler and real time sonography in neurosurgery. Neurosurg. Rev. 7, 199–208 (1984). https://doi.org/10.1007/BF01780705
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DOI: https://doi.org/10.1007/BF01780705