In contmdistinction to the widespread use of imaging ultrasound in exmnining many other l'egions of the body, ultrasonography of the centralnervow; system has been seriously limited because high· frequency ultrasound dues not readily penetrate the bon y covering of this organ system. The difl'iculty in using ultrasound to visualize lm1in and spinal cord structm·es is a paradox in the history of medical ultr:•sonogmphy hecause much of the interest in the early days of this field of diagnostic imaging was in the central nervous system. ~lore than 30 years ago, French et a!. used A-mode s<:anning to localize il subcortical brain tumor in an e:\+ cised postmortem specimen. U! Advances in central nervous system ultrasonography have been made, however, in applic.ltions in which the skull or vertebral bodies have not impeded the pasage of ultrasound waves. There have been three pl'incipal areas of such applkations: postoperative scanning through craniectomy portals, : l .~ imaging through the fontanels of infants,5·6 and intraoperative ultrasonography.Operative use of imaging ultrasound for brain disease was first employed in the 1960s. ' :' "-II However, the A-mode scanning available then presented problems of interpretation which prevented widespread applkation of this dia~nostic tool. ~lore recent adnmces in ultrasound technology, particularly the development of high-resolution real-time B-mode scanners, have eliminated manv of the em~ lier difHculties in operative imaf,ting. This IHL'i re· suited in u renewed trial of ultrasonic scanning in various types of operations on the hrain 1 :2 -:H and spinal cord. ~. 2l iAs part of a pro~ra m to assess the utility of op· erative ultrasonography in a number of surgical dis· ciplines. we employed ultrasound imaging during brain and spinal cord surgery. \Ve have reviewed our experience of spedfic applications in terms of the impact of ultrasonography on management during opemtion. From this analysis we have de· termined the situations in which ultrasonograph~· during neurosurgery can be most helpful. This analvsis has enabled us to establish criteria for the most productive use of ultrasound during brain and spinal cord surgery and is the basis of this report. METHODSOperative ultrasonography during neurosurgical procedures was performed with real-time B-mode instruments employing mechanically driven sectorscanning transducers. High Stoy. Philips, and Dia-155

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Skin necrosis is an unusual complication following venography of the legs. The authors have found only four cases in the English literature. Two cases of skin necrosis following extravasation of contrast medium are reported. Their pathogenesis, clinical course, and treatment are discussed along with methods of prevention.

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