gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Intraoperative matching of online ultrasound power-doppler imaging with preoperative rotational DSA imaging for monitoring of remote vascular changes during aneurysm clipping

Meeting Abstract

  • D. Podlesek - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • T. Meyer - Institut für Elektrotechnik, Abteilung Biomedizin, Technische Universität, Dresden
  • D. Krex - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • G. Schackert - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • U. Morgenstern - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • M. Kirsch - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.06-01

DOI: 10.3205/09dgnc144, URN: urn:nbn:de:0183-09dgnc1446

Published: May 20, 2009

© 2009 Podlesek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Intraoperative high-resolution 3D ultrasound (3DUS) imaging holds the potential to visualize the vascular tree at frequent intervals without the organisational limitations of intraoperative DSA or limitations to the visual field as for ICG angiography.

Methods: Intraoperative 3DUS was used in 50 cases of anterior or middle cerebral artery aneurysms to visualize the vascular tree before and after clipping. Volume scans were obtained using the Voluson 730 ultrasound system. Co-registration with rotational DSA was performed in 30 patients employing the Amira software package. 3D reconstruction was performed using the integrated workstation and an external computer for matching of preoperatively obtained rotational DSA volume data and intraoperative 3DUS Doppler data. In addition, velocity measurements were monitored by conventional microdoppler (16 MHz micro-Doppler probe). To validate intraoperative findings, post-operative DSA were matched with the intraoperative 3DUS volume.

Results: Intraoperative velocity was easily accessed by duplex ultrasonography and correlated well with conventional microdoppler recordings. The vascular tree was reconstructed in 21 of totally 30 Patients. In those, all vessels were identifiable by 3D power doppler and co-registration with pre-operative rDSA. “Hidden” Vessels (behind the aneurysm, or within the parenchyma) were also analysed. The post-clipping 3DUS measurements were insufficient by means of clip artefacts or other technical difficulty in 9 patients. Postclipping 3DUS reconstructions were successful in 11 cases (52%).

Conclusions: This study demonstrates the value of intraoperative 3DUS to visualize all pertinent vessels before and after aneurysm clipping. This technique allows parallel assessment of blood velocity and of 3D vessel configuration. Although resolution is lower than for standard DSA, this method provides immediate intraoperative feedback of the perfusion status of all vessels including penetrating vessels. However, even 3DUS and the reconstruction of 3D-doppler data is difficult to interpret which adds to a high interobserver variability. We suggest that successful online matching should employ online elastic registration, which improves the anatomic interpretation of all – visible and non-visible – vessels.