gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

The role of intraoperative microdoppler in cerebral and spinal arterio-venous malformations

Die Bedeutung des intraoperativen Mikrodopplers bei zerebralen und spinalen Gefäßmalformationen

Meeting Abstract

Suche in Medline nach

  • corresponding author Jan Regelsberger - Neurochirurgische Klinik, Universitätskrankenhaus Eppendorf, Hamburg
  • N. Langer - Neurochirurgische Klinik, Universitätskrankenhaus Eppendorf, Hamburg
  • M. Westphal - Neurochirurgische Klinik, Universitätskrankenhaus Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 10.104

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0387.shtml

Veröffentlicht: 23. April 2004

© 2004 Regelsberger et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

When arterio-venous malformations (AVM) and -fistulas (AVF) are resected and ligated by a neurosurgical approach, all essential vessels and healthy brain and spinal tissue have to be preserved. The surgical approach has to focus first on the arterial blood supply before draining veins are obliterated. Otherwise compromising draining veins during the preparation of an AVM will lead to hazardous congestive bleeding. In this context PW-intraoperative microdoppler (IOMD) was evaluated for its value in guiding the surgical strategy.

Methods

Since 1/2001, 64 cranial AVMs and 12 dural AVFs as well as 9 spinal dural AVFs were operated on in our clinic. IOMD investigations were performed on the supplying and draining vessels to analyze their hemodynamic profile, flow velocities, pulsatility index (PI) and resistance index (RI).

Results

IOMD measurements of systolic and diastolic blood flow were not comparable to data obtained from transcranial doppler (TCD) evaluations. Blood flow velocities by IOMD were significantly lower than by TCD investigations. Nevertheless supplying arterial blood vessels of AVM and AVF were reliable identified by their indices, especially a characteristic low PI<0.72. Venous drainages carrying arterialized blood, showed characteristics of intermediate flow with abnormal high systolic and diastolic blood flow, providing a reliable diagnosis in all investigated pathologies.

Conclusions

In principle IOMD is an easy-to-handle tool, reliable for identifying arterial and venous blood vessels of cerebral arteriovenous malformations, thereby enhancing the safety of the surgical procedure. The young vascular surgeon, in particular, will profit from this quick investigation designed to prevent serious complications. However, further technical improvements have been initiated because we found that high doppler probe angles and low pulse repitition frequencies (PRF) are the major reasons for unexpected low systolic and diastolic flow measurements.