术中超声导航辅助切除脑动静脉畸形

目的探讨术中实时超声导航在脑动静脉畸形(AVM)外科治疗中的应用价值。方法26例脑AVM显微手术切除术中,使用Aloka SSD 4000型超声检查仪扫描,进行AVM定位、辨别供血动脉和引流静脉;确定血肿与AVM的关系以及血流动力学监测。病变切除后重复超声检查AVM残留与否,并与术后脑血管造影结果对比。结果26例畸形血管团均住实时超声下清晰显示并获得全切除。血肿区为高同声无血流信号;供血动脉与正常血管在血流动力学上有差别;术中超声影像所示的病变全切除为术后血管造影所证实。结论术中实时超声能够对脑AVM进行准确定位,指导皮质切口的设计,并可判定病灶是否全切除.对于术前的MRI、DSA检查起到很有价值的补充作用。

The guidance of intraoperative ultrasound in the surgical treatment of intracranial arteriovenous malformation

Objective To investigate the value of intraoperative real-time ultrasound during surgery of cerebral arteriovenous malformations ( AVMs). Methods 26 patients with cerebral AVMs underwent microsurgical treatment. An Aloka SSD 4000 ultrasound system equipped with a intraoperative probe was used. Imaging was performed before the starting of resection in order to localize and delineate the AVM; definite the hematoma and AVM relationship and identify the feeding arteries and draining veins. After removal of the lesion, sonographic examination was repeated to detect the residual AVM tissue, and the findings were compared with post-operative angiographic finding. Results Total resection was achieved in all 26 patients under real-time ultrasonographic examination. The AVM were localized and defined precisel. The hematoma exhibited hyperechogenicity without blood signals. The feeding vessels were distinguished from normal ones hemodynamically. Complete removal of the AVM determined sonographically was then confirmed by angiography. Conclusions Intraoperative real - time ultrasound allows accurate localization of the cerebral AVMs and helps to determine the degree of removal of the cerebral AVM. It provides valuable supplement information for pro-operative MRI and DSA during surgery.