Ultrasonographic superb microvascular imaging for emergency surgery of intracerebral hemorrhage |
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| Institution: | 1. Department of Neurosurgery, Edogawa Hospital, 2-24-18 Higashikoiwa Edogawaku, Tokyo 133-0052, Japan;2. Department of Neurosurgery, Tachikawa Hospital, Tokyo, Japan;3. Department of Neurosurgery, Saiseikai Central Hospital, Tokyo, Japan;4. Department of Neurosurgery, Saitama City Hospital, Saitama, Japan;5. Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan;6. Department of Orthopedics, Edogawa Hospital, Tokyo, Japan;1. Monash University, 900 Dandenong Road, Caulfield East, Victoria 3145, Australia;2. School of Engineering and IT, University of New South Wales, Canberra, Australia;3. Trauma and Orthropaedic Research Unit, Canberra Hospital, Canberra, Australia;1. Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX;2. Department of Radiation Oncology, The Methodist Hospital, Cancer Center and Research Institute, Houston, TX;3. Department of Surgery, The Methodist Hospital, Houston, TX;1. Josef Pflug Vascular Laboratory, Department of Vascular Surgery, Ealing Hospital, Middlesex, United Kingdom;2. Department of Surgery and Cancer, Imperial College, London, United Kingdom;3. Department of Vascular Surgery, Northwick Park Hospital, Middlesex, United Kingdom;1. Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan;2. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan;3. Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan |
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| Abstract: | Ultrasonography (US) has been used as a reliable imaging modality, providing real-time information during neurosurgical operations. One recent innovative US technique, superb microvascular imaging (SMI), visualizes small vessels and flow, which are not detected with standard US with doppler. We apply SMI to intraoperative US monitoring in emergency surgery for intracerebral hemorrhage (ICH).Eleven consecutive patients with ICH underwent endoscopic emergency surgery under US monitoring with SMI. After performing a small craniotomy, US images were obtained using SMI, a fusion technique, and a contrast agent technique, with the probe on the brain surface during surgery. Fusion images were obtained with the probe on the head before craniotomy in some patients.Animated US images with SMI could differentiate hematoma containing no vessels from brain tissue, and flow images using SMI and contrast agent techniques clarified the borderlines. Animated fusion images of intraoperative US and preoperative CT provided information on the extent of hematoma and residual hematoma during emergency surgery. We made various fusion CT images showing intracranial hematoma with US probes and decided on the skin incision line before beginning surgery, as if we were using a neuronavigation system.US with SMI, contrast agent, and fusion techniques provide information on the extent of intracranial hematoma and residual hematoma with no vessels and no flow. Monitoring by US and fusion CT images is useful for ICH surgery as a next-generation neuronavigator. |
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| Keywords: | Ultrasonography Microvascular imaging Intraoperative monitoring Intracerebral hemorrhage |
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