Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique

Part 1: Arteriovenous malformations

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✓ The use of a pulsed echo Doppler technique during surgery for cerebral arteriovenous malformation is described. The equipment and the methods employed are presented. The main advantages are easy determination of flow direction and pattern of the vasculature involved, allowing a precise discrimination between inflow and outflow channels. Deep-seated malformations, not visible at the brain surface, can be located with the Doppler technique. The ultrasound probe was placed on the brain surface with a slight pressure on the intact pia mater. The precise direction and depth of the malformation could be determined in relation to the recording site. This facilitated the planning of cortical incisions, identification of vessels involved, and the vascular procedure to be employed.

Article Information

Address reprint requests to: Helge Nornes, M.D., Department of Neurosurgery, National Hospital of Norway, Rikshospitalet, Oslo, Norway.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Demonstration of probe positions and angles in a transcortical search for deep-seated vessels, aneurysms, and malformations. Only one probe is used in recording situations.

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    Case 1. Records showing identification of two inflow arteries. Vmax = maximum blood flow velocity, Vmean = mean of velocities across vessel lumen. See Fig. 3 for an angiogram of these two vessels.

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    Case 1. Angiograms showing arterial (left) and venous (right) filling. See records in Fig. 2 (“Artery 1” is the most frontally located). The patient has a Pudenz shunt.

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    Case 1. Flow velocities in the main draining vein (see Fig. 3 right). Test occlusions of inflow Artery 1 (arrow 1) and Arteries 1 and 2 (arrow 2) cause a nearly complete arrest of venous flow. Artery 2 is opened and occluded again at arrow 3.

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    Plotting an arteriovenous malformation (AVM) from the brain surface. The probe is sampling from the border of the AVM (left) and moving slowly over the AVM. These AVM channels are located approximately 2.5 cm below the pia mater. Note the highly irregular flow and comparatively high mean velocities.

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    Case 6. Angiogram showing a “tapered” outflow vein. The sites of measurements are indicated by arrows. For description see text.

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