术中多普勒超声及超声血管造影在脑动静脉畸形手术中的应用

Introperative Doppler ultrasonography and ultrasound angiography in operation for brain arteriovenous malformations

目的探讨术中超声及超声血管造影在脑动静脉畸形（AVM）手术中的应用价值，论证供血动脉阻力指数（RI）变化与脑AVM是否全部切除的相关关系。方法对82例脑AVM患者行微创神经外科手术，术中行多普勒超声检查，15例同时行超声血管造影检查，分析AVM声像特点，测量供血动脉RI，比较脑AVM切除前后数值的变化，判断是否存在畸形血管的残存。术中或术后行全脑血管造影（DSA）检查，判定脑AVM是否全部切除。结果彩色多普勒超声可清晰地显示动静脉畸形的范围、边界。畸形血管团内含丰富的血流声像，双色红蓝混杂、方向各异的团状血流信号，优势供血动脉与引流静脉多可辨认。畸形血管切除前，供血动脉RI平均值为0．37±0．08；手术切除畸形血管团后，双色混杂血管团消失，RI平均值为0．63±0．09（P〈0．05）。8例病例清除脑内血肿后，畸形血管团的位置发生了明显移位，术中超声给予重新定位，确定手术探查方向。7例术中超声检查怀疑AVM残留，再次探查证实有畸形血管残存并予以全切除。结论术中多普勒超声可实时进行脑AVM的定位、引导，术中超声血管造影可动态提供脑动静脉畸形的真实血供模式，结合RI使得脑动静脉畸形是否全切除的判定方法更加完善。

Objective To investigate the reliability and clinical value of intraoperative Doppler ultrasonography and ultrasound angiography in treatment of brain arteriovenous malformations （ AVMs ）. We demonstrate the correlation between the change of resistive index （RI） of feeding artery and the completeness of resection of brain AVMs. Methods Intraoperative Doppler ultrasonography was applied in 82 patients with intracranial brain AVMs undergoing resection, and ultrasound angiography was used in 15 of the 82 patients in addition. The resistive index （RI） of the feeding artery was recorded so as to identify the residual AVMs. Intraoperative angiography or postoperative angiography was performed in all patients, Results Intraoperative color Doppler uhrasonography clearly identified the position, size, and flow characteristics of AVMs by showing double colors and directions of flow pattern, the feeding arteries, and draining veins. The mean preresection RI of the feeding artery was （ 0. 37 ± 0.08 ）, and the post-resection RI was （ 0. 63 ± 0. 09 ） （P 〈 0. 05 ）. In 8 cases the AVMs were translocated the translocation so they needed localized and delineated again. In 7 cases residual AVMs were suspected intraoperatively by ultrasonography and were confirmed by rexploration and resected totally. Conclusion Intraoperative Doppler uhrasonography is a reliable tool for intraoperative localization and complete resection of AVMs. Providing real-time flow pattern of AVMs, intraoperative ultrasound angiography combined with RI effectively indicates the completeness of resection of AVMs.