gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Intraoperative contrast-enhanced ultrasound angiography (tUSA) in cerebrovascular surgery – first results

Intraoperative kontrastverstärkte Ultraschallangiographie (tUSA) in der zerebrovaskulären Chirurgie – erste Ergebnisse

Meeting Abstract

  • corresponding author D. Lindner - Klinik für Neurochirurgie, Universitätsklinikum Leipzig
  • C. Renner - Klinik für Neurochirurgie, Universitätsklinikum Leipzig
  • W. Korb - ICCAS Innovation Center Computer Assisted Surgery, Leipzig
  • H. Roth - Klinik für Diagnostische Radiologie, Abteilung für Neuroradiologie, Universitätsklinikum Leipzig
  • C. Trantakis - Klinik für Neurochirurgie, Universitätsklinikum Leipzig
  • J. Meixensberger - Klinik für Neurochirurgie, Universitätsklinikum Leipzig

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocSO.04.04

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Lindner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Intraoperative imaging can improve the safety of clip placement during aneurysm surgery. A potentially effective method is ultrasound angiography (tUSA). New developments allow a visualisation of intracranial vessels and the aneurysm in an angiography-like display with high spatial resolution. The aim of our intraoperative study was the use of contrast enhanced ultrasonography for the first time as a practical technology to visualize cerebral vessel anatomy and flow during and after aneurysm surgery.

Methods: In a prospective study, patients scheduled for aneurysm surgery and with elective cerebral x-ray-angiography were asked to participate. Sonoline Elegra sonography system (Siemens Erlangen, Germany) was used for the intraoperative study. The device was equipped with 2, 5-MHZ phased-array transducer. Transdural ultrasound angiography (tUSA) was acquired with a low acoustic power of 1-3% and a frequency of 1,1 MHZ. tUSA was obtained twice transdural after craniotomy and after clip placement. We used SonoVue (Bracco International) for contrast enhancement. The application was done as a bolus injection of 2, 4 ml (108 µg sulphur hexafluoride) intravenously.

Results: Altogether 10 patients with an aneurysm of the anterior circle of Willis were included in the study (4males/6 females). The age ranged from 30-65 years with a mean age of 47 years. Ultrasound angiography was successfully used twice in all patients during the operation.

We registered no adverse event. Image quality was acceptable or good in all cases for B-Mode and contrast application. After injection and a time delay of 10-18 seconds, the contrast overamplification called “blooming” was recorded. Around 20-30 seconds later the effect was overcome and in all cases we could visualize the aneurysm less than 2 millimetres, the adjacent vessel as well as the aneurysm occlusion after clip placement without artefacts. In all cases the intraoperative findings correlated very well with postoperative x-ray-angiography or MR angiography.

Conclusions: Transdural contrast enhanced ultrasound angiography is adequate for real time visualisation of local and general vessels as well as for intraoperative visualisation of aneurysms less than 2 mm. The quality of the images is comparable to x-ray-angiography with high anatomic resolution. The technique is quick, simple and robust without expensive equipment. Further investigation includes quantitative measurement, perfusion analysis of the aneurysm and the perforating arteries.