Abstract
Objective: The usefulness of intraoperative microvascular Doppler (IMD) in preventing an incorrect placement of the clip during intracranial aneurysm surgery is described. Such incorrect placement of the clip may cause new bleeding or ischemic accident as a consequence of incomplete exclusion of the aneurysm or stenosis/occlusion of the parent and/or adjacent arteries. Methods: One hundred thirty patients, harboring 136 aneurysms, were operated on using IMD. IMD study was performed on the aneurysm and adjacent arterial vessels before and after the clip placement. Mechanical arterial spasm was treated by topical sodium nitroprusside (SNP) and its efficacy verified by IMD. Results: In 55 aneurysms (42.3%), IMD was helpful in understanding the microvascular anatomy before clip placement. Complete exclusion resulted in 129 aneurysms (94.9%). In 5 cases (3.7%) in which IMD revealed a persistent blood flow in the aneurysm, the clip was repositioned. In 2 cases (1.4%), we obtained false-negative results. In 25 cases (18.3%) in which IMD data documented a severe flow reduction in the vessel harboring the aneurysm or in the vessel originating very close to the aneurysm neck, the clip was repositioned. There were no complications due to the use of IMD. In 20 patients (15%) in which IMD revealed arterial spasm by surgical manipulation, topical SNP was followed by resolution of the spasm. Conclusion: IMD is a feasible, safe, and very reliable technique in aneurysm surgery. Compared to other procedures such as intraoperative angiography, the cost efficiency of IMD is favorable.
| Original language | English |
|---|---|
| Pages (from-to) | 336-342 |
| Number of pages | 7 |
| Journal | Surgical Neurology |
| Volume | 63 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2005 |
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Keywords
- Intracranial aneurysm
- Intraoperative Doppler
- Vasospasm
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Intraoperative microvascular Doppler in intracranial aneurysm surgery. / Marchese, Enrico; Albanese, Alessio; Denaro, Luca; Vignati, Andrea; Fernandez, Eduardo; Maira, Guiulio.
In: Surgical Neurology, Vol. 63, No. 4, 04.2005, p. 336-342.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Intraoperative microvascular Doppler in intracranial aneurysm surgery
AU - Marchese, Enrico
AU - Albanese, Alessio
AU - Denaro, Luca
AU - Vignati, Andrea
AU - Fernandez, Eduardo
AU - Maira, Guiulio
PY - 2005/4
Y1 - 2005/4
N2 - Objective: The usefulness of intraoperative microvascular Doppler (IMD) in preventing an incorrect placement of the clip during intracranial aneurysm surgery is described. Such incorrect placement of the clip may cause new bleeding or ischemic accident as a consequence of incomplete exclusion of the aneurysm or stenosis/occlusion of the parent and/or adjacent arteries. Methods: One hundred thirty patients, harboring 136 aneurysms, were operated on using IMD. IMD study was performed on the aneurysm and adjacent arterial vessels before and after the clip placement. Mechanical arterial spasm was treated by topical sodium nitroprusside (SNP) and its efficacy verified by IMD. Results: In 55 aneurysms (42.3%), IMD was helpful in understanding the microvascular anatomy before clip placement. Complete exclusion resulted in 129 aneurysms (94.9%). In 5 cases (3.7%) in which IMD revealed a persistent blood flow in the aneurysm, the clip was repositioned. In 2 cases (1.4%), we obtained false-negative results. In 25 cases (18.3%) in which IMD data documented a severe flow reduction in the vessel harboring the aneurysm or in the vessel originating very close to the aneurysm neck, the clip was repositioned. There were no complications due to the use of IMD. In 20 patients (15%) in which IMD revealed arterial spasm by surgical manipulation, topical SNP was followed by resolution of the spasm. Conclusion: IMD is a feasible, safe, and very reliable technique in aneurysm surgery. Compared to other procedures such as intraoperative angiography, the cost efficiency of IMD is favorable.
AB - Objective: The usefulness of intraoperative microvascular Doppler (IMD) in preventing an incorrect placement of the clip during intracranial aneurysm surgery is described. Such incorrect placement of the clip may cause new bleeding or ischemic accident as a consequence of incomplete exclusion of the aneurysm or stenosis/occlusion of the parent and/or adjacent arteries. Methods: One hundred thirty patients, harboring 136 aneurysms, were operated on using IMD. IMD study was performed on the aneurysm and adjacent arterial vessels before and after the clip placement. Mechanical arterial spasm was treated by topical sodium nitroprusside (SNP) and its efficacy verified by IMD. Results: In 55 aneurysms (42.3%), IMD was helpful in understanding the microvascular anatomy before clip placement. Complete exclusion resulted in 129 aneurysms (94.9%). In 5 cases (3.7%) in which IMD revealed a persistent blood flow in the aneurysm, the clip was repositioned. In 2 cases (1.4%), we obtained false-negative results. In 25 cases (18.3%) in which IMD data documented a severe flow reduction in the vessel harboring the aneurysm or in the vessel originating very close to the aneurysm neck, the clip was repositioned. There were no complications due to the use of IMD. In 20 patients (15%) in which IMD revealed arterial spasm by surgical manipulation, topical SNP was followed by resolution of the spasm. Conclusion: IMD is a feasible, safe, and very reliable technique in aneurysm surgery. Compared to other procedures such as intraoperative angiography, the cost efficiency of IMD is favorable.
KW - Intracranial aneurysm
KW - Intraoperative Doppler
KW - Vasospasm
UR - http://www.scopus.com/inward/record.url?scp=15944370291&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=15944370291&partnerID=8YFLogxK
U2 - 10.1016/j.surneu.2004.05.031
DO - 10.1016/j.surneu.2004.05.031
M3 - Article
C2 - 15808715
AN - SCOPUS:15944370291
VL - 63
SP - 336
EP - 342
JO - Surgical Neurology
JF - Surgical Neurology
SN - 0090-3019
IS - 4
ER -