Benedito J A Pereira1, Vanessa M Holanda2, Miguel Giudicissi-Filho3, Luiz Alencar B Borba4, Carlos Vanderlei M de Holanda3, Jean G de Oliveira2. 1. Division of Cerebrovascular and Skull Base Surgery, Department of Neurosurgery, Center of Neurology and Neurosurgery Associates (CENNA), Hospital Beneficência Portuguesa de São Paulo-SP, Brazil; Division of Neurosurgery, Department of Medical Sciences, School of Medicine, University Nove de Julho (UNINOVE), São Paulo-SP, Brazil. Electronic address: benedito.jamilson@hotmail.com. 2. Division of Cerebrovascular and Skull Base Surgery, Department of Neurosurgery, Center of Neurology and Neurosurgery Associates (CENNA), Hospital Beneficência Portuguesa de São Paulo-SP, Brazil; Division of Neurosurgery, Department of Medical Sciences, School of Medicine, University Nove de Julho (UNINOVE), São Paulo-SP, Brazil. 3. Division of Cerebrovascular and Skull Base Surgery, Department of Neurosurgery, Center of Neurology and Neurosurgery Associates (CENNA), Hospital Beneficência Portuguesa de São Paulo-SP, Brazil. 4. Division of Cerebrovascular and Skull Base Surgery, Department of Neurosurgery, Center of Neurology and Neurosurgery Associates (CENNA), Hospital Beneficência Portuguesa de São Paulo-SP, Brazil; Department of Neurosurgery, School of Medicine, Federal University of Paraná (UFPR), Curitiba-PR, Brazil.
Abstract
OBJECTIVE: To analyze the impact of the introduction of Micro-Doppler vascular (MDV) as a method of cerebral blood flow analysis during microsurgical clipping of intracranial aneurysms to check the partial occlusion of the aneurysm and the occurrence of stenosis by comparing these results with those provided by the postoperative digital subtraction angiography (DSA) scan as well as the occurrence of ischemic infarction on the postoperative computed tomography (CT) images. PATIENTS AND METHODS: We reviewed retrospectively the last 50 patients operated on before the introduction of the MDV (group 1) compared with the first 50 patients operated on using this technique (group 2). RESULTS: Nine (18%) of the 50 patients evaluated in the group 1 showed a new hypodensity in the postoperative CT images, whereas only 2 (4%) patients showed infarction in the group 2 (P = 0.02). In addition, in the group 1, 10 (20%) patients presented unexpected findings on DSA images (residual aneurysms, stenosis, and arterial occlusion), whereas in the group 2, those unexpected DSA findings were observed in only 3 (6%) patients (P = 0.023). CONCLUSION: MDV is an excellent method for cerebral blood flow assessment during the microsurgical clipping of intracranial aneurysms, reducing the unexpected angiographic results (residual aneurysms, stenosis, and arterial occlusion), as well as reducing the incidence of ischemic infarction on postoperative CT images, evidence of the positive impact of this method in the microsurgical treatment of intracranial aneurysms.
OBJECTIVE: To analyze the impact of the introduction of Micro-Doppler vascular (MDV) as a method of cerebral blood flow analysis during microsurgical clipping of intracranial aneurysms to check the partial occlusion of the aneurysm and the occurrence of stenosis by comparing these results with those provided by the postoperative digital subtraction angiography (DSA) scan as well as the occurrence of ischemic infarction on the postoperative computed tomography (CT) images. PATIENTS AND METHODS: We reviewed retrospectively the last 50 patients operated on before the introduction of the MDV (group 1) compared with the first 50 patients operated on using this technique (group 2). RESULTS: Nine (18%) of the 50 patients evaluated in the group 1 showed a new hypodensity in the postoperative CT images, whereas only 2 (4%) patients showed infarction in the group 2 (P = 0.02). In addition, in the group 1, 10 (20%) patients presented unexpected findings on DSA images (residual aneurysms, stenosis, and arterial occlusion), whereas in the group 2, those unexpected DSA findings were observed in only 3 (6%) patients (P = 0.023). CONCLUSION:MDV is an excellent method for cerebral blood flow assessment during the microsurgical clipping of intracranial aneurysms, reducing the unexpected angiographic results (residual aneurysms, stenosis, and arterial occlusion), as well as reducing the incidence of ischemic infarction on postoperative CT images, evidence of the positive impact of this method in the microsurgical treatment of intracranial aneurysms.
Authors: Stavros Dimitriadis; Fares Qeadan; Christopher L Taylor; Howard Yonas; Andrew P Carlson Journal: Oper Neurosurg (Hagerstown) Date: 2018-10-01 Impact factor: 2.703