微血管多普勒超声在颅内动脉瘤手术中的应用

目的探讨微血管多普勒(microvascular Doppler,MVD)在颅内动脉瘤手术中的作用。方法应用MVD对20例颅内动脉瘤患者(共计21个动脉瘤)进行动脉瘤夹闭前后监测,记录动脉瘤、载瘤动脉及分支的血流速度和频谱,根据MVD检查结果重新调整瘤夹。结果所有动脉瘤患者均探及瘤体内呈毛刺样、涡流样杂音频谱。15例动脉瘤夹闭的患者中,3例因载瘤动脉或分支血管狭窄而调整动脉瘤夹位置;动脉瘤夹闭术后,瘤体内均未探及血流信号,无音频和频谱显示,证实已被完全夹闭,而载瘤动脉及分支血流频谱波动性良好;8例动脉瘤患者术中运用MVD协助区分巨大动脉瘤和载瘤动脉走行。结论动脉瘤夹闭术中运用MVD同步进行动脉瘤及载瘤动脉血流动力学监测,可根据检查结果调整动脉瘤夹位置,具有无创、简单易行,安全的特点。建议MVD作为颅内动脉瘤手术的常规监测方法,尤其对瘤颈粗、甚至无明显瘤颈的巨大动脉瘤手术具有指导意义。

Application of intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery

Objective To explore the role of intraoperative microvascular Doppler(MVD)in cerebral aneurysm surgery and to assess the impact of this method on the surgical procedure itself.Methods 20 patients with 21 saecular cerebral aneurysms were assessed by MVD before and after aneurysm clipping.The parameters of blood flow velocities and plateau waves in the aneurysmal sac,parent artery and some adjacent arteries were recorded.Analysis was also made of the cases in which the clip was repositioned according to MVD findings.Results The vascular murmur could be easily detected by MVD in all aneurysm.A relevant stenosis of parent artery or its branching arteries induced by clip positioning that had escaped detection by visual inspection was identified by MVD in 3 out of 15 aneurysms.After aneurysm clipping,MVD demonstrated absent flow signal in the domes of all aneurysms indicating these domes were obliterated completely,while it disclosed clearly the patterns,direction,and velocity of blood flow of the parent artery and their branches suggesting patency of these arteries.The gaint aneurysm could be easily distinguished from parent artery by using MVD in 8 out of 20 cases.Conclusion MVD could detect the cerebral hemodynamic changes with intraoperative aneurysms and parent artery in noninvasive way and is easy to perform during operation.The clip could be repositioned on the basis of the MVD results.It is recommended that MVD be used routinely in cerebral aneurysm surgery,especially in those gaint aneurysms with wide neck or without neck.