gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 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

Published: September 16, 2010

© 2010 Uzma 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

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.