Intraoperative Microvascular Doppler Sonography in Aneurysm Surgery

Akdemir, Hidayet; Oktem, Ibrahim; Tucer, Bülent; Menkü, Ahmet; Basaslan, K.; Günaldı, Ömür

doi:10.1055/s-2006-954577

Cited by 45 publications

(21 citation statements)

References 26 publications

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“…Interestingly, the use of a microvascular Doppler probe was a significant predictor of post-IA clip adjustment. While others have found microvascular Doppler assessment to be useful in aneurysm surgeryv,17 25 our results are not consistent with these previous studies. Our hypothesis is that microvascular Doppler is insensitive to posterior wall remnants outside of the operative field of view and vessels receiving collateral or retrograde flow.…”

Section: Discussioncontrasting

confidence: 99%

Comparing routine versus selective use of intraoperative cerebral angiography in aneurysm surgery: a prospective study

Washington

Derdeyn

Chicoine

et al. 2014

J NeuroIntervent Surg

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IntroductionWhile the use of intraoperative angiography (IA) has been shown to be a useful adjunct in aneurysm surgery, its routine use remains controversial.ObjectiveWe wished to determine if IA is required in all patients undergoing aneurysm surgery (ie, routine IA) or if intraoperative assessment can reliably predict the need for IA (ie, select IA).MethodsWe prospectively evaluated all patients undergoing craniotomy for aneurysm clipping. In these patients, the treating surgeons were asked to record whether they felt IA was required at two time points: (1) prior to surgery and (2) immediately after clip application but before IA. All patients underwent IA as per the institutional protocol. IA results and the need for post-IA clip adjustments were recorded.ResultsOf the 200 patients enrolled, 197 were included for analysis. IA was deemed necessary on preoperative assessment in 144 cases (73%) and on post-clip assessment in 116 cases (59%). Post-clip IA demonstrated 47 (24%) positive findings and post-IA clip adjustments were made in 19 of 198 cases (10%). On preoperative assessment, there were four cases where IA was deemed unnecessary, yet post-IA clip adjustment was required, resulting in a sensitivity of 79% and false negative rate of 8%. Regarding post-clip assessment, there were five cases where IA was thought to be unnecessary and clip adjustment was required, resulting in a sensitivity of 73% and false negative rate of 6%.ConclusionsThe accuracy of a strategy of select IA was not improved by assessing the need for IA immediately after aneurysm clipping versus prior to surgery onset. This suggests that intraoperative assessment regarding the adequacy of aneurysm clip application should be viewed with caution.

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Section: Discussioncontrasting

confidence: 99%

Comparing routine versus selective use of intraoperative cerebral angiography in aneurysm surgery: a prospective study

Washington

Derdeyn

Chicoine

et al. 2014

J NeuroIntervent Surg

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“…The application of other intraoperative additional methodologies also turned out to be especially useful in the treatment of VB aneurysms; intraoperative doppler to test patency of afferent vessels after clipping has been used in nearly every case [Akdemir, 2006;Kapsalaki, 2008]; more recently, we have used intraoperative fluoroangiography [Raabe, 2005;Dashti, 2009] and endoscopic assistance to microneurosurgery, which has revealed particularly effective in the treatment of lesions located in the distal portion of basilar artery [Taniguchi, 1999;Kalavakonda, 2002;.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Skull Base Approaches for Vertebro-Basilar Aneurysms

Galzio¹,

Paulis²,

Cola³

2012

Explicative Cases of Controversial Issues in Neurosurgery

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“…During microvascular surgery, it is of utmost importance to observe blood flow for checking complete occlusion of aneurysm, intact flow through the parent vessels and non-occlusion of perforating arteries, ensuring patency of bypass vessels and understanding the microsurgical anatomy of arteriovenous malformations (AVM) and dural arteriovenous fistula (dAVF) [1][2][3]. Neurovascular surgeon has various modalities in his armamentarium like Doppler ultrasonography, indocyanine green video angiography (ICG-VA), conventional angiography and endoscopic visualization.…”

Section: Introductionmentioning

confidence: 99%

Real-time patency verification during clipping aneurysm and STA-MCA by-pass with dual-image videoangiography

Tanaka¹,

Shatokhin²,

Senko³

et al. 2018

Romanian Neurosurgery

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The dual-image videoangiography (DIVA) is a new tool which helps identify vessels and surrounding structure. This method is based on use of indocyanine green video angiography (ICG-VA) technology on real time microscopic operative image. In this two case, we report of using DIVA in STA-MCA bypass surgery of 46 years old, female patient of stenosis of right MCA. And using DIVA during clipping ICA paraclinod aneurysm of 35 years old, female. During surgery, it helped in identifying temporal and frontal branches of the STA and there careful selection. After anastomosis, DIVA was used to refine vessel patency and functioning of the anastomosis. DIVA has the potential to replace ICG-VA as a tool for checking the patency of graft during bypass procedures and obliteration of aneurysm along with surgical procedures for AVM and d-AVF. DIVA allows visualization of vessels against a background of normal brain and has better visualization at greater depth and high magnification. This is particularly important during bypass surgery, which very often is performed in deep surgical fields and high magnification.

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Intraoperative Microvascular Doppler Sonography in Aneurysm Surgery

Cited by 45 publications

References 26 publications

Comparing routine versus selective use of intraoperative cerebral angiography in aneurysm surgery: a prospective study

Comparing routine versus selective use of intraoperative cerebral angiography in aneurysm surgery: a prospective study

Skull Base Approaches for Vertebro-Basilar Aneurysms

Real-time patency verification during clipping aneurysm and STA-MCA by-pass with dual-image videoangiography

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