外伤性颈内动脉海绵窦瘘(TCCF)介入治疗前后经颅多普勒超声检测的临床意义

目的 检测外伤性颈内动脉海绵窦瘘(Traumatic carotid cavernous fistula,TCCF)介入治疗前后脑动脉血流动力学变化。方法 对16例TCCF患者采用TCD检测颅底主要动脉的血流速度、脉动指数、频谱形态、声频变化。结果治疗前患侧动脉出现快流速，低脉动指数、紊乱频谱血流信号伴明显杂音，尤以眼上静脉的异常为主。栓塞后异常血流信号消失。结论 TCD是协助诊断CCF的无创伤方法。是监测介入治疗后CCF是否完全栓塞的重要手段，压颈工序对了解侧枝循环非常重要。     

颈动脉海绵窦瘘的经颅多普勒超声研究

采用彩色三维经颅多普勒观察18例颈动脉海绵窦瘘血流情况，发现其引流静脉多以眼上静脉为主、患侧颈内动脉流速明显高于健侧，患慎MCA，ACA流速低于健侧，压迫患侧颈总动脉，患侧颈内动脉(痿口以上)出现不同程度的倒灌血流。眼上静脉动脉化且血流反向的频谱特点及患侧颈内动脉倒灌血流为颈内动脉海绵窦瘘的特征性表现。经眶窗检测颈内动脉虹吸段时，其流速受瘘口所在位置的影响。观察颅内盗血情况可粗略估价瘘口大小。经颅多普勒检测颈动脉海绵窦瘘还可了解病人Willis环代偿能力，为必要时行一侧颈内动脉闭塞提供参考依据。     

颈动脉-海绵窦瘘的经颅多普勒超声研究

采用彩色三维经颅多普勒超声观察18例颈动脉-海绵窦瘘血流情况，发现其引流静脉多以眼上静脉为主．患侧颈内动脉流速明显高于健侧；患侧MCA、ACA流速低于健侧；压迫患侧颈总动脉，患侧颈内动脉(瘘口以上)出现不同程度的倒灌血流，眼上静脉的动脉化且血流反向的频谱特征为颈动脉-海绵窦瘘最典型的表现．其流速与瘘口大小，引流路径及流量的高低相关。经眶窗检测颈内动脉虹吸段时，其流速受瘘口所在位置的影响，观察颅内盗血情况可粗略估计瘘口大小．TCD检测颈动脉-海绵窦瘘还可了解病人Willis环代偿能力，为必要时行一侧颈内动脉闭塞提供客观依据。     

颈动脉-海绵窦瘘的经颅多普勒超声研究

采用彩色三维经颅多普勒超声观察18例颈动脉-海绵窦瘘血流情况,发现其引流静脉多以眼上静脉为主,患侧颈内动脉流速明显高于健侧;患侧MCA、ACA流速低于健侧;压迫患侧颈总动脉,患侧颈内动脉(瘘口以上)出现不同程度的倒灌血流,眼上静脉的动脉化且血流反向的频谱特征为颈动脉-海绵窦瘘最典型的表现,其流速与瘘口大小,引流路径及流量的高低相关.经眶窗检测颈内动脉虹吸段时,其流速受瘘口所在位置的影响,观察颅内盗血情况可粗略估计瘘口大小.TCD检测颈动脉-海绵窦瘘还可了解病人 Willis环代偿能力,为必要时行一侧颈内动脉闭塞提供客观依据.     

外伤性颈内动脉海绵窦瘘患者介入治疗的血液动力学分析

目的 应用经颅多普勒超声（TCD）观察外伤性颈内动脉海绵窦瘘（CCF）患者介入治疗（可脱式球囊栓塞术）前后的血液动力学变化。方法 回顾分析2000年2月至2007年10月间介入治疗的18例外伤性CCF患者的TCD结果,并将手术前后的TCD与数字减影血管造影术（DSA）的检查结果进行比较。结果 经DSA证实的18例CCF患者15例行可脱式球囊栓塞术,DSA证实手术一次成功;2例术中改为ICA闭塞术,术后DSA显示患侧ICA完全闭塞;另1例术中出现血管痉挛而被迫放弃手术。术前TCD检测：（1）17例患侧颈内动脉颅外段和（或）颈内动脉虹吸段血流速度加快,脉动指数（PI）值均减低,其中颈内动脉虹吸段加快者伴频谱紊乱。（2）10例患侧大脑中动脉（MCA）、16例患侧大脑前动脉（ACA）血流速度减慢伴PI值下降。（3）11例患侧大脑后动脉（PCA）、14例健侧ACA流速加快,频谱形态正常。（4）16例患侧、2例双侧眼上静脉（SOV）呈现反向的静脉动脉化频谱。术后1周及6个月后复查TCD显示,15例球囊栓塞患者术前异常的颈内动脉及SOV等血管的血液动力学参数均恢复或接近正常,2例行ICA闭塞术患者TCD显示患侧ICA完全闭塞（患侧大脑后动脉及健侧大脑前动脉流速加快）。结论 TCD可以实时、动态的观察CCF患者颅内、外血管的血流及频谱改变,为临床提供可靠的血液动力学信息。     

外伤性颈动脉海绵窦瘘血管内治疗探讨

目的 探讨对外伤性颈动脉海绵窦瘘(TCCFs)的血管内治疗方法。方法 240例TCCFs病人，其中214例采用可脱性球囊栓塞，23例采用弹簧圈栓塞(5例经股静脉→岩上窦人海绵窦内栓塞)，3例经眼上静脉人海绵窦内栓塞(2例采用微弹簧圈栓塞，1例采用NBCA胶栓塞)。结果 214例采用可脱性球囊栓塞，198例保持颈内动脉通畅，通畅率92．5％，随访，除1例在半年后复查发现原瘘口处假性动脉瘤外(因无症状，未处理)，其余痊愈516例行颈内动脉闭塞，其中3例分别在1—2个月发现颈外动脉分支与海绵窦相通，经真丝线段，NBCA栓塞而愈。其余26例全部治愈。结论 大多数TCCFs病人可通过可脱性球囊和弹簧由血管内栓塞而治愈，但可脱性球囊应首选。     

外伤性颈内动脉海绵窦瘘血管内栓塞治疗

外伤性颈内动脉海绵窦瘘(traumatic carotid cavernous fistula,TCCF)是颅内常见的动静脉瘘,手术治疗难度很大.目前认为,经血管内介入栓塞治疗是TCCF治疗的首选方法.我院自1997年至今,采用血管内栓塞的方法治疗TCCF患者9例,取得了满意的疗效,现将我们的诊治体会报告如下.     

外伤性颈动脉海绵窦瘘反复鼻衄的诊断和治疗

目的 总结８例外伤性颈动脉海绵窦瘘（ＴＣＣＦ）反复迟发性大量鼻衄。方法 ８例ＴＣＣＦ合并鼻衄患者入院前采用鼻腔填塞和颈动脉压迫止血。８例中有７例行急诊脑血管造影和血管内治疗,术中采用球囊闭塞ＴＣＣＦ的瘘口或闭塞颈内动脉的方法。结果 脑血管造影发现８例中有５例合并假性动脉瘤征象。１例治疗前死亡,６例治愈,１例反复鼻衄者经三次血管内治疗不成功,通过内窥镜直接用肌肉填塞获得成功．结论 ＴＣＣＦ合并反复大     

可脱性球囊介入治疗外伤性颈内动脉海绵窦瘘

目的探讨外伤性颈内动脉海绵窦瘘的临床特征及应用可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘的血管内介入治疗技术。方法10例外伤性颈内动脉海绵窦瘘患者常规行脑血管造影检查明确诊断,应用法国Bait公司产Magic．BDTE可脱性球囊,在数字减影监视下,施行可脱性球囊栓塞治疗。结果1次栓塞成功7例,2次栓塞成功2例,因并发症鼻腔出血死亡1例。结论可脱性球囊栓塞治疗是目前治疗外伤性颈内动脉海绵窦瘘的最好方法,其具有损伤小,安全性高和疗效可靠的特点。     

外伤性颈内动脉海绵窦瘘栓塞治疗

目的通过对15例外伤性颈内动脉海绵窦瘘(TCCF)的血管内可脱球囊栓塞治疗，总结球囊栓塞的优点。方法15例TCCF均使用球囊栓塞。结果其中14例次性栓塞成功．1例不全栓塞，经随访半年仍获满意疗效。所有病例颈内动脉均保持通畅。结论球袭栓塞应作为治疗TCCF的首选方法。     

Functional transcranial Doppler assessment of cerebral blood flow velocities changes during attention tasks

Background and Purpose:  Aim of our study was to evaluate cerebral hemodynamic changes during performance of attention tasks and to correlate them with reaction time (RT) and percentage of right answers.
Methods:  Mean flow velocity (MFV) in middle cerebral arteries was monitored in 30 subjects by transcranial Doppler during tonic alertness, phasic alertness, focused and divided attention tasks.
Results:  Mean flow velocity increase was significantly higher during divided attention with respect to other tasks ( P  < .001). MFV increase was higher in the right than in the left side ( P  < .001). Asymmetry during attention tasks resulted significantly higher than that observed in tonic alertness condition. RT was increased during focused attention tasks ( P  < .001 vs. both alert tasks), with further increase during divided attention tasks ( P  < .001 vs. focused attention task). RT was inversely related to MFV increase only during tonic alertness ( P  = 0.012 for left side; P  = 0.008 for right side). During the divided attention tasks, an association was found between MFV increase and correct answers ( r  = 0.39, P  = 0.033).
Conclusions:  These data show a relationship between RT, correct answers and changes in blood flow velocity and suggest that this method of cerebral blood flow investigation could be a useful approach during assessment of patients with attention deficit.     

Cerebrovascular CO2 reactivity in migraine: assessment by transcranial Doppler ultrasound

Summary Cerebrovascular reactivity to CO₂ inhalation was studied by transcranial Doppler sonography in 30 patients with classic or common migraine and 39 healthy controls without clinical or ultrasonic signs of arteriosclerosis. Systolic and diastolic Doppler frequencies of the middle cerebral artery were plotted against end-tidal CO₂ partial pressure; the reactivity index (I×R) was defined as relative frequency change during a PCO₂ increase of 5 mm Hg. In the normal subjects, I×R was 20.0±6.3 for systolic velocities, and 26.0±8.2 for diastolic values. Migraineurs during their headache-free interval had significantly higher I×R values on the affected side (mean: 41.6 systolic, 61.2 diastolic), compared with either controls (P<0.01) or the contralateral side (mean: 28.3 systolic, 30.8 diastolic; P<0.01). During the headache attack, CO₂ reactivity was significantly lower than normal only for systolic velocities (mean: 8.3; P<0.05). Increased CO₂ reactivity is thought to be one phenomenon of migraine. Transcranial Doppler CO₂ testing of cerebrovascular reactivity is a reliable method that may be of interest for the diagnostic evaluation and management of migraine patients.     

Preoperative risk assessment for carotid occlusion by transcranial Doppler ultrasound.

OBJECTIVES: An endovascular carotid balloon occlusion test with continuous intracranial monitoring by transcranial Doppler sonography was performed in 55 patients for prediction of tolerance of a required permanent occlusion of the carotid artery. METHODS: Blood flow velocities of the ipsilateral middle cerebral artery during occlusion were recorded and compared with clinical tolerance during an occlusion test as well as with postoperative outcome after an eventual permanent occlusion. To stress the capacity of the cerebral circulation to tolerate the occlusion acetazolamide was injected before occlusion in all patients. RESULTS: The onset of neurological symptoms during temporary occlusion was dependent on the percentage fall of mean blood flow velocity relative to baseline rather than on absolute flow velocities during the time of occlusion. Patients with a fall of mean flow velocity of less than 30% tolerated temporary and permanent occlusion, with the exception of two patients who developed an infarction due to thromboembolism after iatrogenic sacrifice of the carotid artery. Patients with a major decrease developed neurological symptoms during occlusion in 55% and, in cases of carotid ligation, a haemodynamic infarction occurred. CONCLUSION: The results show that transcranial Doppler monitoring as a part of an endovascular balloon occlusion test may be a reliable technique for preoperative risk assessment for permanent occlusion of the carotid artery.     

Utility of transcranial Doppler ultrasound for the integrative assessment of cerebrovascular function

There is considerable utility in the use of transcranial Doppler ultrasound (TCD) to assess cerebrovascular function. The brain is unique in its high energy and oxygen demand but limited capacity for energy storage that necessitates an effective means of regional blood delivery. The relative low cost, ease-of-use, non-invasiveness, and excellent temporal resolution of TCD make it an ideal tool for the examination of cerebrovascular function in both research and clinical settings. TCD is an efficient tool to access blood velocities within the cerebral vessels, cerebral autoregulation, cerebrovascular reactivity to CO(2), and neurovascular coupling, in both physiological states and in pathological conditions such as stroke and head trauma. In this review, we provide: (1) an overview of TCD methodology with respect to other techniques; (2) a methodological synopsis of the cerebrovascular exam using TCD; (3) an overview of the physiological mechanisms involved in regulation of the cerebral blood flow; (4) the utility of TCD for assessment of cerebrovascular pathology; and (5) recommendations for the assessment of four critical and complimentary aspects of cerebrovascular function: intra-cranial blood flow velocity, cerebral autoregulation, cerebral reactivity, and neurovascular coupling. The integration of these regulatory mechanisms from an integrated systems perspective is discussed, and future research directions are explored.     

Three-dimensional transcranial Doppler blood flow mapping in patients with cerebrovascular disorders

We investigated 60 patients with cerebrovascular disorders using a three-dimensional transcranial Doppler blood flow mapping system. A composite display of the circle of Willis is created with computer assistance, allowing accurate vessel identification and optimal data documentation of blood flow velocity and direction in the basal cerebral arteries. The basilar artery was insonated in every patient; the middle cerebral artery and the most distal internal carotid artery were found in 95% of the patients, the anterior cerebral artery in 85%, and the posterior cerebral artery in 84%. Insonation problems occurred predominantly in elderly women. Transcranial Doppler blood flow mapping showed an abnormal result in 23 of 60 patients (38%). An intracranial stenosis with greater than 50% diameter reduction or occlusion was found in 10 of 31 patients (32%) with completed stroke, reversible ischemic neurologic deficit, or transient ischemic attack. Collateral blood flow mechanisms could be demonstrated in patients with extracranial carotid artery occlusions. Intra-arterial cerebral angiography performed in 21 patients confirmed the transcranial Doppler blood flow mapping diagnosis in 19 (90.5%). In one patient an arteriovenous malformation diagnosed by transcranial Doppler blood flow mapping was confirmed by magnetic resonance imaging.     

Cerebral blood flow during vagus nerve stimulation--a transcranial Doppler study

BACKGROUND AND OBJECTIVES: Vagus nerve stimulation (VNS) is an approved treatment of partial onset seizures and has recently shown antidepressant effects in patients with treatment-resistant depression. This study was conducted to investigate whether acute VNS has an influence on cerebral blood flow (CBF) in humans. METHODS: This investigation was designed as an add-on study. In 10 patients with an implanted stimulator who participated in a multicenter clinical trial to evaluate the efficacy of VNS in depression, CBF was investigated by functional transcranial Doppler at baseline (before the stimulator was turned on for the first time) and during stimulation with three different stimulation intensities in a randomized order. RESULTS: Immediately after every increase of the current, CBF velocity showed a nonsignificant increase. Otherwise, no change of CBF above standard deviation could be registered. CONCLUSION: Acute VNS does not have an influence on CBF velocity in depressive patients.     

Noninvasive transcranial Doppler ultrasound in intracranial angiomas

Transcranial Doppler ultrasound is a noninvasive method to evaluate flow velocities in the basal cerebral arteries. It can provide hemodynamic data like velocity distributions, intracranial steal phenomena, and functional stenoses in angiomas as illustrated in four patients. This information may supplement conventional neuroradiologic procedures for therapeutic decisions and follow-up.