gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Integration of 3D-doppler ultrasound in navigated neurosurgery of AVMs as an intraoperative tool for the extent of resection

Meeting Abstract

  • M.J. Shah - Abteilung für Allgemeine Neurochirurgie, Universitätsklinikum Freiburg
  • R. Sircar - Abteilung für Allgemeine Neurochirurgie, Universitätsklinikum Freiburg
  • S. Gläsker - Abteilung für Allgemeine Neurochirurgie, Universitätsklinikum Freiburg
  • V. van Velthoven - Abteilung für Allgemeine Neurochirurgie, Universitätsklinikum Freiburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.08

DOI: 10.3205/11dgnc073, URN: urn:nbn:de:0183-11dgnc0735

Published: April 28, 2011

© 2011 Shah 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: The aim of this study was to evaluate the efficacy and feasibility of a navigated intraoperative doppler ultrasound for the assessment of the extent of resection in arteriovenous malformation (AVM) surgery.

Methods: In 20 consecutive patients with arteriovenous malformations (Spetzler-Martin grade 1–3), an ultrasound navigation system (Sonowand) was used. After craniotomy, a 3D-doppler ultrasound scan was performed. Resection of the AVM was then performed. Complete resection was confirmed by a follow-up doppler ultrasound scan. Pre- and postresectional ultrasound scans were easily comparable. Postoperative conventional angiography was routinely performed to detect remnant vascular malformation.

Results: With the use of intraoperative 3D-doppler ultrasound, it was possible to detect the nidus of the AVM in all cases. The integration of 3D-ultrasound into the neuronavigation system (Sonowand) allows for a direct comparison of pre- and postresection Doppler images and could successfully confirm total resection. In one patient, the postresectional ultrasound scan showed a suspicious remnant nidus, which let to further resection. Conventional postoperative angiography demonstrated total resection in all patients. No ultrasound-associated morbidity or mortality was seen.

Conclusions: The integration of the ultrasound data into a navigation system enabled a direct comparison of different stages during the resection procedure. In our series, intraoperative ultrasound was an adequate control of complete resection. Further experience might eventually prove that invasive postoperative angiography can be omitted.