微血管多普勒在脑动脉瘤夹闭术中的应用

The application of microvascular Doppler during the cerebral aneurysm clipping

目的探讨微血管多普勒(MVD)在脑动脉瘤夹闭术中的应用价值。方法在23例26个脑动脉瘤夹闭前、后,使用MVD对动脉瘤、载瘤动脉和相关穿支动脉检测血流动力学的改变。动脉瘤夹闭后,瘤体内涡流存在时,加强瘤颈的夹闭力,载瘤动脉或穿支动脉血流降低或消失时,改变动脉瘤夹夹闭位置,使载瘤动脉和或穿支动脉的血流恢复至正常。结果所有动脉瘤均检测到涡流或毛刺样血流信号。21个动脉瘤夹闭术后,瘤体内涡流消失,载瘤动脉及其分支血流频谱良好;3个动脉瘤行孤立术后,瘤体内频谱消失,2个巨大动脉瘤行动脉瘤夹闭加清除术。动脉瘤夹闭术中,不完全夹闭2个动脉瘤,4个动脉瘤载瘤动脉血流速度增快,调整动脉瘤夹夹闭位置后,血流速度恢复正常。术后头颅CT示,所有病例无脑梗死。3例眼动脉瘤、2例小脑后下动脉瘤和1例小脑上动脉瘤出院前作DSA检查,动脉瘤消失,载瘤动脉和相关血管无闭塞或狭窄现象。其他病例均作CTA复查,载瘤动脉及周围血管保留良好,动脉瘤消失。结论MVD在动脉瘤夹闭术中是一种安全直接,快速简便和经济有效的监测方法。

Objective To evaluate the value of intraoperative microvascular Doppler sonography （MVD） in the cerebral aneurysm clipping. Methods Before and after clipping MVD was used to confirm the obliteration of aneurysm and the patency of parent vessels and branch arteries in 26 aneurysms among 23 patients who underwent surgery. When the turbulent flow appeared in the aneurysm after clipping, the dipping force would be strengthened; when the blood flow of parent vessels and branch arteries fell or disappeared, the clipping location would be changed. Results The laminar and turbulent flow appeared in all aneurysms. The turbulent flow disappeared in 21 aneurysms after clipping and the patency of parent and branch vessels was normal. When 3 aneurysms were trapped, the turbulent flow disappeared. Clipping and excision were performed in 2 giant aneurysms. Incomplete obliteration was detected in 2 aneurysms and vascular stenosis was detected in 4 aneurysms by MVD. The dipping location was adjusted in all cases according to the MVD findings until the normalized flow velocities appeared on the MVD. Cranial CT was performed on all cases after aneurysm surgery and there was no cerebral infarct signs. DSA or CTA showed aneurysms disappeared and the patency of parent and branch vessels was normal. Conclusion Intraoperative microvascular Doppler is a safe, simple and reliable method which can be routinely used in aneurysm surgery.