术中B超辅助切除脑动静脉畸形

Intraoperative Real-time Ultrasound During Surgery of Cerebral Arteriovenous Malformations

目的:探讨术中实时超声在脑动静脉畸形(AVM)外科治疗中的应用价值。方法:15例脑AVM患者接受显微外科治疗,术中病变切除前行超声检查,以定位AVM边界与周围脑组织结构关系;辨别供血动脉和引流静脉;确定血肿与AVM的关系。病变切除后重复超声检查AVM残留与否,并与术后血管造影结果对比。结果:15例患者病变均在实时超声导航下获得全切除。畸形血管团可被准确定位和界定范围,血肿区为高回声无血流信号,供血动脉血流动力学有别于正常血管,术中超声影像上病变的全切除为血管造影所证实。结论:术中实时超声能对脑AVM进行准确定位,并可判定脑AVM的全切除;AVM术中定位可为术前MRI、DSA起到有价值的补充。

Aim： To investigate the value of intraoperative real-time ultrasound during surgery of cerebral arteriovenous malformations（AVMs）. Methods： 15 patients with cerebral AVMs underwent microsurgical treatment. Intraoperative ultrasound was performed before the starting of resection in order to localize and delineate the AVM, definiting the hematoma and AVM relationship and identifying the feeding arteries and draining veins. After removing of the lesion, sonographic examination was repeated to detect the residual AVM tissue and the findings were compared with post-operative angiographic finding. Results： Total resection was achieved in all 15 patients under real-time ultrasonographic examination. The AVM were localized and defined precisely. The hematoma exhibited hyperechogenicity without blood signals. The feeding vessels were distinguished from normal ones bemodynamically. Complete removal of the AVM determined sonographically was then confirmed by angiography. Conclusion： Intraoperative real-time ultrasound allows accurate localization of the cerebral AVMs and helps to determine the degree of removal of the cerebral AVM. It provides valuable supplement information for prooperative MRI and DSA during surgery.