Application of Intraoperative Ultrasonography in the Resection of Intracranial Arteriovenous Malformation_West China Medical Journal

Authors：

YAO Wenhua ¹ , ZHANG Deming ¹ , ZHU Chengming ¹ , WANG Guifu ² , LIU Qi ¹

1. Department of Ultrasound, Ya’an People’s Hospital,Ya’an, Sichuan 563000, P. R. China; 2. Zunyi Medical College, Zunyi, Guizhou 563003, P. R. China;

Corresponding?author：

Keywords：

顱內動靜脈畸形; 外科手術; 術中超聲; 預后

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【摘要】　目的　探討顱內動靜脈畸形切除術中彩色多普勒超聲檢查的應用價值與預后的關系。　方法　在顯微外科手術的基礎上，將65例動腦靜脈畸形患者隨機分為A、B兩組， A組34例動靜脈畸形患者在術中接受術中超聲檢查，確定其畸形血管團的數目、位置、深度、大小、范圍及其與周邊組織結構的關系，探查供血動脈及引流靜脈的數目及走行，以確定動、靜脈畸形的位置、手術切除范圍及切除術后是否有畸形血管殘留；B組31例行常規手術，比較兩組之間的差異。　結果　術中彩色多普勒超聲能清晰的顯示動靜脈畸形的情況，兩組經手術完整切除動靜脈畸形率、再出血率、術后7 d Glasgow昏迷評分及預后差異均有統計學意義（P lt;0.05）。　結論　術中實時彩色多普勒超聲能對腦動靜脈畸形準確定位，并可判定腦動靜脈畸形的血供模式及殘余情況，減少腦組織損傷及降低手術并發癥的發生，提高了手術安全性及治療效果。
【Abstract】　Objective　 To explore the application of the colored Doppler ultrasonography in the excision of intracranial arteriovenous malformation (AVM) to determine the location of the lesion and the completeness of the resection, and to evaluate the clinical value of intraoperative ultrasonography in the diagnosis, treatment and the relation to the prognosis of patients.　Methods　 A total of 65 patients with brain AVM were randomly divided into group A and B. The microsurgery was perfromed on the patients. Intraoperative ultrasound was performed on the 34 patients in group A to the numbers, location, depth,size of different malformation vascular clumps relationship of the arteriovenous malformation with surrounding tissues. While the pateints in group B underwent the routine surgery. The difference between the two groups were compared.　Results　 The condition of the AVM were clearly revealed by intraoperative ultrasonography. All of the intracranial AVM in group A were completely removed. The difference in rehaemorrhagia and postoperative Glasgow coma scale score of seven day between the two groups were statistically significant (P lt;0.05).　Conclusions　 Intraoperative color Doppler ultrasounography in the resection of intracranial AVM could accurate localize the lesions, identify vascular anatomy of the AVM vascular balls and the completeness of resection. The parameters including resistance index of the vessels may identify the abnormal vessels and reduce the operative complications and brain tissue damage, which improve the safety and efficacy of the therapeutic effect.

Citation： YAO Wenhua,ZHANG Deming,ZHU Chengming,WANG Guifu,LIU Qi. Application of Intraoperative Ultrasonography in the Resection of Intracranial Arteriovenous Malformation. West China Medical Journal, 2011, 26(6): 896-899. doi: Copy

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1. 　中華神經科學會, 中華神經外科學會. 全國第四屆腦血管病學術會議: 腦卒中臨床療效評定標準[J]. 中華神經科雜志, 1996, 29(6): 381 - 383.
2. 　姜笑千, 何文, 趙繼宗, 等. 顱內動靜脈畸形的術中超聲應用研究[J/CD]. 中華醫學超聲雜志(電子版), 2006, 3(4): 213-215.
3. 　Cokluk C, Lyigun O, Senel A, et al. The guidance of intraoperativeUltrasonography in the surgical treatment of arteriovenous malformation[J]. Minim Invasive Neurosurg, 2003, 46(3): 169-172.
4. 　王立淑, 何文, 劉會晤, 等. 顱內血管網織細胞瘤的術中超聲應用研究[J/CD]. 中華醫學超聲雜志(電子版), 2008, 5(2): 255-260.
5. 　Dempsey RJ, Moftakhar R, Pozniak M. Intraoperative Doppler to measure cerebrovascular resistance as a guide to complete resection of arteriovenous malformations[J]. Neurosurgery, 2004, 55(1): 155-160.
6. 　Griffith S, Pozniak MA, Mitchell CC, et al. Intraoperative sonography of intracranial arteriovenous malformations, how we do it[J]. J Ultra sound Med, 2004, 23(8): 1065-1072.
7. 　周大彪, 趙繼宗, 王碩, 等. 術中實時超聲在腦動靜脈畸形外科治療中的應用[J]. 中華醫學雜志, 2005, 85(24): 1688-1691.
8. 　劉承基. 腦血管外科學[M]. 南京: 江蘇科學技術出版社, 2000: 10-26.
9. 　王忠誠. 王忠誠神經外科學[M]. 湖北科學技術出版社, 2004: 867-874.
10. 　Erdogan N, Tucer B, Mavili E, et al. Ultrasound guidance inintracranial tumor resection: correlation with postoperative magnetic resonance findings[J]. Acta Radiol,2005, 46(7): 743-749.
11. 　王怡, 王涌, 楊永明. 術中超聲在神經外科手術中的應用價值[J]. 中國醫學影像技術, 2004, 20(2): 227-229.

West China Medical Journal

Application of Intraoperative Ultrasonography in the Resection of Intracranial Arteriovenous Malformation

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