Clip readjustment in aneurysm surgery after flow evaluation using the ultrasonic perivascular probe: case report

Abstract

-Occlusion or stenosis of a parent vessel or its distal branches is a major cause of poor patient outcome after cerebral aneurysm surgery. Despite great attempts to preserve patency at the time of clip application, intraoperative visual observation may not reveal arterial compromise or occlusion. Quantitative measurement of blood flow in cerebral vessels during aneurysm surgery can help prevent ischaemia and improve patient outcome. We report a case of a large complex middle cerebral artery (MCA) aneurysm in which perivascular microflow probes were used to measure blood flow quantitatively in MCA and its branches before and after aneurysm clipping. Following aneurysm clipping, blood flow in the MCA branches were significantly reduced to less than its initial baseline value with occlusion of the inferior M2 segment. Prompt detection of compromised blood flow gave the surgeon the opportunity to adjust the clip. This adjustment was performed several times until restore MCA flow to its preclipping values. Intraoperative quantitative vessel-flow measurements were safe and may have prevented cerebral ischaemia and neurological deficit to this patient.KEY WORDS: ultrasonic perivascular transit-time flow probe, aneurysm surgery, middle cerebral artery.Reajuste do clipe na cirurgia de aneurisma após avaliação do fluxo arterial por meio de microsonda ultrasônica perivascular: relato de caso RESUMO -A medida quantitativa do fluxo sanguíneo nos vasos cerebrais durante a cirurgia de aneurisma pode ajudar na prevenção de eventos isquêmicos e, portanto, melhorar os resultados. Relatamos o caso de paciente portador de aneurisma grande e complexo da bifurcação da artéria de cerebral média (ACM), no qual foram usadas micro-sondas ultrasônicas perivasculares para medir o fluxo de sangue quantitativamente na ACM e nos seus ramos antes e depois da clipagem do aneurisma. Após a clipagem do aneurisma, o fluxo de sangue diminuiu em todos os ramos, fazendo-se necessário o reajuste do clipe. Após vários ajustes na posição do clipe, o fluxo sanguíneo nos segmentos da ACM foi restabelecido. A descoberta imediata da alteração do fluxo de sangue proporcionou a oportunidade ao cirurgião de ajuste do clipe e conseqüente-mente o restabelecimento do fluxo a valores compatíveis àqueles antes da clipagem. O uso de micro-sondas ultrasônicas perivasculares para medida do fluxo sanguíneo durante a cirurgia de aneurisma pode prevenir eventos isquêmicos e eventualmente déficits neurológicos. PALAVRAS-CHAVE: micro-sonda ultrasônica perivascular, fluxo sanguíneo, aneurisma, artéria cerebral média.

Bathing Epilepsy: Report of Three Caucasian Cases

“…However, complex partial seizures are reported with higher frequency (67-80%) ( 5 ). As in many other types of reflex seizures, the same stimulus (hot water) triggers either generalized tonic-clonic or partial seizures, suggesting that generalized and localized epilepsies might be influenced by the same afferent pathways ( 7 , 8 , 9 , 10 ). Half of patients may present with spontaneous seizures, which may precede or follow typical reflex seizures by months to years, with an average of 5 years ( 1 ).…”

Editorial. The use of ICG videoangiography and FLOW 800 analysis

“…The value of true intraoperative quantification of arterial flow is well established and has been used for nearly 2 decades. 2,3 The senior author has used intraoperative measurements of arterial flow (not velocity) since 1999 routinely in cerebrovascular surgery and finds it of immense value in bypass surgery (for ischemia, moyamoya disease, and aneurysms) and aneurysm clipping. The technique is complementary to ICG-VA.…”

Monitorización intraoperatoria de la presión tisular de oxígeno: aplicaciones en neurocirugía vascular

“…La arteriografía cerebral, a pesar de considerarse como patro n oro (gold standard) para el diagnóstico de una reducción significativa del rCBF, no puede ser realizada de forma intraoperatoria en la mayoría de centros neuroquirúrgi-cos de nuestro entorno por falta de medios técnicos. Además, aunque diferentes autores han demostrado la utilizad de la arteriografía para el diagnóstico y la corrección intraoperatoria en el mismo acto quirúrgico, el tiempo necesario para llevar a término esta técnica diagnóstica no permite un resultado inmediato y, por lo tanto, su utilidad para evitar la aparición de lesiones isquémicas intraoperatorias es controvertida [3][4][5][6][7][8][9][10][11][12] .…”