Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique

Part 2: Saccular aneurysms

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✓ The use of a pulsed echo Doppler technique during procedures for occlusion of intracranial aneurysms is described. Saccular aneurysms can be located with reference to probe position and depth setting. Tracings of intra-aneurysmal flow are presented, and the characteristic flow pattern is discussed. Special emphasis has been placed on the parent artery flow, particularly the effect of lumen reduction on flow velocity. Results of flow velocity studies on the cognate (direct) and collateral flow in the middle cerebral artery and the proximal anterior cerebral artery are presented and discussed.

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.

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Figures

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    Schematic drawing showing a surgeon homing in on a middle cerebral artery trifurcation aneurysm. Two Doppler probe positions are shown. The dotted lines indicate the ultrasound beam.

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    Intra-aneurysmal flow velocity tracings of a middle cerebral artery aneurysm in a 31-year-old woman. Vmax = maximum velocity; Vmean = mean of flow velocities in the sampling area. Note the difference between nearly zero Vmean and very high and irregular Vmax values. The section between arrows 1 and 2 is a recording from a trifurcation branch obtained by a slight change in probe position. See Fig. 1.

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    Schematic drawing of a sampling situation. For a description, see text.

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    Drawing demonstrating a moderate lumen reduction of parent vessel at A2 due to the application of a clip. Blood-flow velocity will increase (V2) at that site according to the simple equation shown below drawing. V = mean blood flow velocity; A = vessel lumen area at site of measurement.

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    Velocity tracings in a 57-year-old man, showing the effect of a tight clip position (center tracing). Sampling is from the parent artery at the clip site (see A2 in the schematic drawing in Fig. 4). Permanent clip application is shown (right tracing). Vmax = maximum velocity; Vmean = mean of flow velocities in the sampling area; ABP = arterial blood pressure.

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    Flow velocities in middle cerebral artery (MCA) trifurcation branch with spasm in a 29-year-old woman. This marked increase in flow velocity compensates, within certain limits, for the effect of lumen reduction on bulk flow in the artery. Note the high end-diastolic flow velocity. Vmax = maximum velocity; Vmean = mean of flow velocities at the sampling area; ABP = arterial blood pressure.

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    Reversal of flow in proximal anterior cerebral artery (ACA) during a short test occlusion of the distal internal carotid artery (ICA) in a 68-year-old woman. Vmax = maximum velocity; Vmean = mean of flow velocities at the sampling area; ABP = arterial blood pressure.

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    Test occlusion of the internal carotid artery (ICA) while recording from the middle cerebral artery (MCA) in a 57-year-old man. Compare the cognate and collateral flow velocities. Vmax = maximum velocity; Vmean = mean of flow velocities at the sampling area; ABP = arterial blood pressure.

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