Directional Doppler sonography of the supratrochlear and extracranial cerebral arteries was performed on 16 patients without any cerebral flow, as confirmed angiographically. The findings were inconsistent for the supratrochlear artery, but the internal carotid and vertebral arteries had characteristic changes in the Doppler curve with clearly diminished systolic flow velocity and flow reversal during diastole. These results were never seen in arteriosclerotic occlusion, hypoxaemic or toxic cerebral oedema. Doppler sonography thus helps to formulate indications for early cerebral angiography.

In 100 normal subjects the flow velocity in the terminal segments of the vertebral arteries and the basilar artery was investigated by suboccipital transcranial Doppler sonography. In normal cases, flow velocity and direction are not sufficient criteria to differentiate these arteries. Using anatomical and haemodynamical parameters it can be shown that a Doppler signal originating from the basilar artery cannot be expected in a depth of less than 85 mm, thus being deeper than it is usually reported in the literature. Due to methodological limitations, the basilar artery cannot be insonated in about 30% of cases.

No abstract

In a series of 231 carotid operations in 202 patients, 8 patients were operated on bilaterally by staged (group A), and 15 patients by simultaneous procedures (group B). Additionally 4 patients had a combined external carotid desobliteration plus extra-intracranial arterial bypass (group C), 3 of them in a simultaneous operation. Patients of the groups A and C had an uneventful recovery throughout. An additional group A patient, however, died during the staging interval due to an ischemic cerebral infarction at the not-yet-operated side. In group B one patient died after myocardial reinfarction and 4 showed other complications: diffuse hematoma of the neck, temporary palsy of the hypoglossal nerve, temporary left brainstem deficit and respiratory failure. Nevertheless, it is concluded that simultaneous bilateral carotid reconstruction offers specific benefits i.e. no risky interval, no second anesthesia and a reduced hospitalization period, and can therefore be recommended in selected cases.

Electronic sector scanning (ESS) is a new two-dimensional ultrasonic technique which provides continuous and instantaneous cross-sections of intracranial structures through the intact skull, including the ventricles and large cerebral arteries, by means of a stationary probe. 2. The efficiency of the ESS in the diagnosis of brain tumors and extracerebral hematomas in 295 neuroradiologically controlled cases out of an unselected number of patients during 1972-1974 is described. 3. Supratentorial brain tumors can be detected directly with the ESS by abnoramal reflections of the tumors as well as indirectly by displacement of intracranial reference structures, mainly the ventricular borders. In 239 cases of suspected brain tumor, 126 were neurodiologically confirmed as supratentorial brain tumors. Among these 126 brain tumors the correct localization was determined by the ESS in 86.5%. 4. The highest reliability of the ESS proved to be the direct demonstration of frontal tumors (93%), whereas space-occupying lesions near the midline could be shown only in 79%. Up to now there have been difficulties in the diagnosis of tumors situated near bony structures, e.g., calvarian meningiomas. 5. Subdural hematomas (56 patients) could be lateralized correctly in 93%. Hwever, direct demonstration of the border of the hematomas could be achieved only in 48,2%. Chronic subdural hematomas in children are easier to recognize and the border could be demonstrated in 18 out of 19 cases. 6. The clinical applicability and diagnostic values of the ESS as a nontraumatic investigation procedure are discussed in comparison to cerebral angiography, pneumoencephalography, brain scintigraphy, and CAT scan. scintigraphy, and CAT scan.