彩色多普勒超声辅助全切除颅内动静脉畸形的临床观察

Intra-operative measurement of RI by colored Doppler for brain AVM surgery

目的探讨颅内动静脉畸形切除术中应用彩色多普勒超声判断动静脉畸形的范围及切除的完整程度。方法对24例颅内动静脉畸形者供血动脉测定阻力指数(resistiveindex,RI),辨别供血动脉及引流静脉。切除畸形后,对供血动脉再次扫描,通过切除前、后RI值的对比来判断畸形是否全切除。结果切除畸形前应用彩色多普勒超声扫描,影像精确显示了畸形的部位及范围。其供血动脉的平均RI值为0.36,畸形全切除后的平均RI值为0.62。2例患者切除后扫描显示有畸形血管残留,其供血动脉RI值仍保持低水平。对残留畸形再次切除后,其供血动脉RI值明显升高。结论术中应用彩色多普勒超声扫描对畸形血管周围动脉的RI值测定,可鉴别供血动脉。通过对畸形血管切除前、后的影像以及供血动脉RI值的对比,可判断畸形血管是否全切除。

Objective To explore the use of the colored Doppler to help to determine the location, completeness of removal of brain AVM during the AVM surgery. Methods A total of 24 brain AVM cases were enrolled in our study and all were treated by minimal invasive surgery. During the operation, colored Doppler was used to detect the location and region of AVM, especially the RI （resistive index） were measured to differentiate the feeding arteries and draining veins. After removal of AVM, colored Doppler was repeated. The ultrasound image and RI data were compared to determine if the AVM were removed totally or not. Results All 24 cases were diagnosed by angiogram. During the operation, the ultrasound image of colored Doppler could be used to detect the location and region of AVM clearly. The mean RI of AVMs＇ feeding arteries was 0.36 before and 0.62 after removal of AVM. In 2 cases, the colored Doppler data helped the surgeons to find the residual abnormal vessels after removal of AVMs＇ nidus, because the RI of feeding arteries was kept at low level. After total removal of AVM, the RI of feeding arteries was elevated markedly. The AVM of all the 24 cases were confirmed to be removed totally by postoperative angiogram. Conclusions During the brain AVM surgery, colored Doppler can be used to determine the location and region of AVM. Moreover, it can be used to differentiate the feeding arteries of AVM by measuring the vessels＇ RI. After the operation, repeated colored Doppler and comparing with the preoperative image and RI date is quite useful for determining completeness of removal of AVMs.