术中微血管多普勒超声检查对颅内动脉瘤治疗的临床意义

目的评价术中微血管多普勒超声（MDU）对颅内动脉瘤手术的指导意义。方法对46例颅内动脉瘤病人共51个动脉瘤进行了47次开颅手术。术中分别在动脉瘤夹闭前及夹闭后应用MDU对动脉瘤和邻近血管进行血流速度的检查。结果MDU证实在47次动脉瘤手术中,有6次由于瘤夹位置而导致邻近血管狭窄或闭塞,而肉眼观察未发现（占12．76％）;另外,在51个动脉瘤中,MDU发现1个动脉瘤在夹闭后未完全闭塞（占1．96％）。夹闭后出现血管狭窄或闭塞以及动脉瘤夹闭不全的发生率与动脉瘤大小密切相关。在前交通和颈内动脉动脉瘤手术中发生血管狭窄的几率相对偏高。结论在颅内动脉瘤手术中,应常规应用术中MDU,特别是对于巨大动脉瘤和没有明显瘤颈的动脉瘤,以及前交通和颈内动脉动脉瘤的病例。

Intraoperative microvascular Doppler ultrasonography monitoring in intracranial aneurysm surgery

OBJECTIVES: To evaluate the reliability of intraoperative microvascular Doppler ultrasonography (MDU) in cerebral aneurysm surgery. METHODS: MDU was conducted among 46 patients with 51 cerebral aneurysms undergoing 47 operations to examine the blood flow velocity in the aneurysmal sac and in the adjacent vessels before and after aneurysm clipping. RESULTS: MDU verified 6 cases of stenosis or occlusion of an adjacent vessel induced by clip positioning that had escaped detection by visual inspection (12.76%, 6/47). In addition, MDU demonstrated that one out of the 51 aneurysms failed to be occluded (1.96%). The incidence of stenosis, occlusion of adjacent vessel, and aneurysm failing to be occluded was closely correlated with the size of aneurysm, and such conditions were prone to occur in anterior communicating artery (ACoA) and internal carotid artery (ICA) aneurysms. CONCLUSION: MDU should be used routinely in cerebral aneurysm surgery, especially in cases of giant aneurysms and aneurysms without obvious neck. In cases of ACoA and ICA aneurysms, MDU is more useful.