Slavomir Kondoff1, Nurfet Alioski1, Toma Spiriev1, Jeliazko Vassilev2, Georgi Simeonov2, Christina Kostadinova2
1) Department of Neurosurgery, Tokuda Hospital Sofia, Bulgaria
2) Department of Anesthesiology, Tokuda Hospital Sofia, Bulgaria
Disclosure: The author has declared no conflicts of interest.
Received: 24.05.15 Accepted: 08.06.15
The aim of the study was to evaluate the usefulness of intraoperative duplex sonography in the treatment of large (17-24 mm) and giant (>25mm) intracranial aneurysm.
Methods: A Retrospective clinical review of 13 cases of giant and large aneurysm treated in Tokuda Hospital Sofia, Bulgaria. Results: The preoperative location of the aneurysm was as follows: MCA 6 pts (46%), ICA -5 pts (38%), ICA-Ophthalmic 1pt (8%) AcomA – 1pt (8%). Intraoperative Ultrasound (IOUS) used in all of the cases for intraoperative visualization of the aneurysm, adequate clip position. Endoscopy was applied additionally in 4 of the cases (31%). The IOUS visualization of distal blood flow achieved in 4 out of 13 patients (30%). Due to the IOUS image clip reposition was done in 1 pt (8%). In 10 pts (77%), clipping of the aneurysm was performed, and 3 cases (23%) the aneurysms were treated by wrapping. On postoperative CTA controls, complete aneurysm obliteration was observed in all clipped patients. In 3 (23%) patients under IOUS guidance, the aneurysmal walls were reduced in size using bipolar coagulation with the further good presentation of the aneurysmal neck, which allowed adequate clip placement.
Conclusion: The initial experience with this technique indicates that it is a reliable tool for blood flow evaluation in large and giant aneurysms, as well as the presence intraluminal thrombosis and calcifications in the aneurysm wall. The data from IOUS facilitates a more secure microsurgical dissection and in some situations gives additional data needed for clip repositioning and intraoperative diagnosis. The combination of IOUS and endoscopy provides additional information, which could aid the management of these lesions.
Keywords: intraoperative ultrasonography, intraoperative duplex sonography, giant aneurysm, large aneurysm
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Citations, Quotes & Annotations
- brain aneurysm signs
- cerebral aneurysm
- brain sonography
- duplex sonography aneurysm
- large aneurysm treatment
- images of brain aneurysm
- brain surgery
- slavomir kondoff
- toma spiriev
- Nurfet Alioski
- Jeliazko Vassilev
- Georgi Simeonov
- Christina Kostadinova
- tokuda hospital sofia
- tokuda neurosurgery
- ivan inkov
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