术中实时超声在脑动静脉畸形外科治疗中的应用

目的 探讨术中实时超声在脑动静脉畸形(AVM)外科治疗中的应用价值。方法 13例脑AVM(幕上12例,幕下1例)接受显微外科治疗,病变切除前进行多模式的术中超声扫描用以：(1)定位和描述AVM边界;(2)辨别栓塞与灌注区;(3)识别供血动脉和引流静脉。病变切除后重复超声检查以发现AVM的残留并与术中和／或术后血管造影结果对比。结果 13例病变均在实时超声导航下获得全切除。畸形血管团由于具有双色血流特征均可被准确定位和界定范围,栓塞区为高回声无血流信号,供血及引流血管的形态和血流动力学有别于正常血管;术中超声影像上病变的全切除为血管造影所证实。结论术中实时超声能够对脑AVM进行准确定位和导航,为手术提供有价值的信息;并可判定脑AVM的全切除。

Application of intraoperative real-time ultrasound in the surgical treatment of cerebral arteriovenous malformation

Objective To investigate the value of intraoperative real-time ultrasound during surgery of cerebral arteriovenous malformations (AVMs). Methods Thirteen patients with cerebral AVMs, 12 supratentorial and 1 infratentorial, underwent microsurgical treatment. Intraoperative ultrasound (IOUS) with multimodality was performed before the starting of resection in order to: (1) localize and delineate the AVM, (2) differentiate the embolized and perfused parts of AVM, and (3) 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 the intra- and/or post-operative angiographic finding. Results Total resection was achieved in all 13 patients with AVM under real-time ultrasonographic navigation. The niduses of AVM were localized and defined precisely by IOUS due to their dichromatic flow pattern. The embolized parts of AVM exhibited hyperechogenicity without blood signals. The feeding and draining vessels were distinguished from normal ones morphologically and hemodynamically. Complete removal of the AVM determined sonographically was then confirmed by angiography. Conclusions Intraoperative real-time ultrasound allows accurate localization and navigation of the cerebral AVMs, provides valuable information during surgery, and helps determine the degree of removal of the cerebral AVM.