Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Over the last 20 years, several intraoperative adjuncts, including ultrasonography, neuronavigation, and angiography, have been said to aid the intraoperative localization and resection of cerebral arteriovenous malformations (AVMs). The authors assessed the value of intraoperative Doppler ultrasonography in conjunction with neuronavigation during surgery for cerebral AVMs in the pediatric population.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors reviewed all cranial AVM resections performed by a single surgeon at their institution in the period from 2007 to 2013 and here describe their experience and results in a series of 20 consecutive AVM resections in 19 pediatric patients. Intraoperative Doppler ultrasonography had been used in conjunction with preoperative CT or neuronavigational MRI. Preoperative and postoperative clinical findings, patient age, and Spetzler-Martin AVM grade were identified in all patients.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>All patients, whose ages ranged from 2 to 16 years, underwent craniotomy and excision of an AVM, which was supratentorial in 18 cases and infratentorial in 2. Patients in 11 cases underwent preoperative embolization, and all other patients underwent cerebral angiography prior to surgery, except for 2 patients who were urgently surgically treated because of low Glasgow Coma Scale scores and associated hematoma. Spetzler-Martin Grades I (3 cases), II (6), III (7), and IV (4) AVMs were represented in this series. Intraoperative Doppler ultrasound provided high-quality images in all cases and demonstrated the location, size, and flow characteristics of the AVM and any associated hematoma. Delayed postoperative cerebral angiography demonstrated successful AVM resection in all cases. An assessment of clinical outcomes revealed no new long-term neurological deficits at 3 months postoperatively.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Intraoperative Doppler ultrasonography is a reliable and useful tool for intraoperative localization and guidance for AVM resection in the pediatric population. When used in conjunction with neuronavigation equipment and modern microscopes, this technique has shown a very high complete resection rate with extremely low associated morbidity.</jats:p></jats:sec>

Long-term hemorrhagic risk in pediatric patients with arteriovenous malformations

“…48 In regard to pediatric patients with AVMs, this rate is 0.3%-4.3% for patients who underwent radiosurgery, 2,3,8,9,17,21,29,37,42,43,54,56,57 and 0%-0.3% for patients after resection. 8,16,50 To the best of our knowledge, this is the first study attempting to compare posttreatment hemorrhagic risk across different treatment modalities in a single cohort of pediatric patients with AVMs. According to our results, patients treated with microsurgical resection experienced the best outcome with no subsequent hemorrhages (0.0%).…”

Preoperative Ultrasound-Guided Wire Localization of the Lateral Femoral Cutaneous Nerve

“…US has been used intraoperatively to find intracranial hematomas or tumors, to guide intraventricular shunt catheter insertion, or for arteriovenous malformation resection. [9][10][11] USWL is a known technique in breast biopsies and soft tissue metastatic melanomas. [12][13][14][15][16] Spinner et al have used it to resect an accessory axillary muscle.…”

ASNM and ASN joint guidelines for transcranial Doppler ultrasonic monitoring: An update

“…Microvascular probes are now available for intracranial application in the assessment of cerebral hemodynamics during cerebral aneurysm [4][5][6] and arteriovenous malformation surgeries. [7][8][9] These probes have a diameter of 1.5 mm or less and employ a carrier frequency of 16 or 20 MHz. These probes can be placed on the vessel of interest using either a malleable wand or rigid suction cannula.…”