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61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Image-guided intracranial B-scan endosonography

Meeting Abstract

  • Naureen Uzma - Klinik für Neurochirurgie, Georg-August-Universität Goettingen, Germany
  • Sven Rainer Kantelhardt - Klinik für Neurochirurgie, Georg-August-Universität Goettingen, Germany
  • Ingmar Thiemann - BrainLAB AG, Feldkirchen, Germany
  • Antonia Hennings - BrainLAB AG, Feldkirchen, Germany
  • Veit Rohde - Klinik für Neurochirurgie, Georg-August-Universität Goettingen, Germany
  • Alf Giese - Klinik für Neurochirurgie, Georg-August-Universität Goettingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1743

DOI: 10.3205/10dgnc214, URN: urn:nbn:de:0183-10dgnc2144

Veröffentlicht: 16. September 2010

© 2010 Uzma 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 vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Neurosurgical ICU-treatment requires sedation over prolonged periods. ICP-monitoring and frequent CCT scans are mandatory to diagnose adverse events. CCT-scanning is time-consuming and endangers patients with elevated ICP. ICP-monitoring provides no structural information. Imaging by intracranial endosonography may offer an alternative. Generally the skull limits sonography for intracranial imaging. Imaging through cranial defects has been shown to provide high resolution images of intracranial structures, but with a limited imaging window. We investigated a navigation image-guided intracranial B-scan image catheter for intracranial monitoring.

Methods: We applied the system in a porcine model of intracranial hemorrhage (n=2). Following anaesthesia and MRI for image-guidance, an endosonography catheter was introduced into the frontal lobe via a 3 mm bur whole. After imgaing anatomical sites and vascular territiories, a hemorrhage was placed via a second bur hole on the contralateral side. For ultrasound imagingm, we used an Acuson ultrasound unit with a 10 F B-scan image catheter. For sufficient anatomical orientation the ultrasound catheter was connected to a VectorVision2 neuronavigation device modified to overlay anatomical MRI images with the imaging plane of endosonography.

Results: Intracranial ultrasound demonstrated anatomical structures with high definition. By means of an overlay of sonographic images and MRI-based image guidance, the ultrasound-catheter could be directed to preselected structures and defined anatomical landmarks. Application of the doppler-mode allowed observation of blood-flow of intracranial vessels. Image-guidance provided orientation of specific bloodvessels. Ultrasound imaging demonstrated the formation of experimental hematoma and brain edema in real-time. Comparison of ultrasound scans with a posthemorrhagic MRI showed a high reliability of the overlay and high definition of endosonography.

Conclusions: We demonstrated that intracranial B-scan imaging provides high definition images of intracranial structures and allows real-time monitoring of intracranial lesions. We suggest that bold screw mounted B-scan image-catheters placed through bur holes into the ventricular system may prove to be a valuable tool for intracranial monitoring of ICU patients.