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Combined Use of Color Doppler Ultrasound and Contrast-Enhanced Ultrasound in the Intraoperative Armamentarium for Arteriovenous Malformation Surgery.
- Source :
-
World neurosurgery [World Neurosurg] 2021 Mar; Vol. 147, pp. 150-156. Date of Electronic Publication: 2021 Jan 05. - Publication Year :
- 2021
-
Abstract
- Background: Safety and efficacy in surgical treatment of cerebral arteriovenous malformations (AVMs) are dictated by thorough understanding of angioarchitectural features, intraoperative identification of feeding vessels, and appreciation of surrounding eloquent areas. Our aim was to describe the preliminary results of combined application of color Doppler ultrasound (CDUS) and contrast-enhanced ultrasound (CEUS) in a consecutive surgical series of AVM. We pointed out the tool's efficacy in distinguishing feeding from bystander vessels and in identifying pattern of venous drainage. We examined its role as an adjunct for semiquantitative evaluation of the nidus inflow.<br />Methods: We used combined CDUS and CEUS in patients surgically treated for cerebral AVMs. We adopted these techniques following a designed protocol to guide safer AVM resection as an adjunct to indocyanine green videoangiography. Intraoperative assessment by ultrasound was performed before, during, and following nidus resection.<br />Results: Four surgically treated cerebral AVMs availed of the ultrasound protocol. Postoperative conventional angiography showed complete resection of the AVMs. CDUS and CEUS proved to be valuable adjunctive tools to indocyanine green videoangiography and micro-Doppler in properly navigating and discerning vascular structures, especially vessel feeders from bystanders. The protocol allows us to identify flow direction, estimate blood velocity within the nidus, and appreciate flow modifications following temporary clipping. Ultimately, it allows us to evaluate the degree of nidus deafferentation, residual flow, restoration of venous drainage and absence of arteriovenous shunts.<br />Conclusions: The CDUS and CEUS protocol is safe and repeatable and works as real-time imaging, further supporting complete surgical resection of AVMs.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Arteriovenous Fistula diagnostic imaging
Cerebral Angiography
Coloring Agents
Female
Fluorescein Angiography
Humans
Indocyanine Green
Intracranial Arteriovenous Malformations diagnostic imaging
Intraoperative Care methods
Male
Middle Aged
Multimodal Imaging methods
Rupture, Spontaneous
Ultrasonography methods
Arteriovenous Fistula surgery
Contrast Media
Intracranial Arteriovenous Malformations surgery
Ultrasonography, Doppler, Color methods
Subjects
Details
- Language :
- English
- ISSN :
- 1878-8769
- Volume :
- 147
- Database :
- MEDLINE
- Journal :
- World neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 33359527
- Full Text :
- https://doi.org/10.1016/j.wneu.2020.12.076