Utilidad del micro doppler intraoperatorio en el clipaje de aneurismas cerebrales
Experiencia en el Hospital Infantil Universitario de San José
DOI:
https://doi.org/10.51437/nj.v24i3.20Resumen
Resumen: Presentamos nuestra experiencia con 8 pacientes que fueron llevados a clipaje de aneurismas cerebrales empleando micro doppler vascular, para verificar la adecuada oclusión del mismo. Se midieron las velocidades de flujo de los vasos aferentes y eferentes del aneurisma y de su domo, antes y posterior al clipaje, para tal fin se utilizó Micro Doppler Hadeco DVM 4500 Bidireccional, con capacidad para medir vasos con diámetro desde 0.1 hasta 20mm. 100% de nuestros casos mostraron clipaje completo de los aneurismas con ausencia de flujo al verificarse con el Doppler,. Un aneurisma es decir el 12.5 % evidencio durante el control angiográfico la persistencia parcial de flujo, el cual se atribuyó a la complejidad de su morfología y a su localización en la punta de la Arteria Basilar. Ninguno de nuestros pacientes presentó deterioro neurológico o signos clínicos o radiológicos de vasoespasmo cerebral en el posoperatorio. Proponemos el uso rutinario del Doppler Intraoperatorio al tratarse de un método no invasivo, confiable y seguro.
Citas
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Weir B. Unruptured intracranial aneurysms: A review. J Neurosurg. 2002; 96:3–42. [PubMed: 11794601].
Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. Unruptured intracranial aneurysms:Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003; 362:103–110. [PubMed: 12867109].
Bederson JB, Awad IA, Wiebers DO, Piepgras D, Haley EC, Brott T, et al. Recommendations for the management of patients with unruptured intracranial aneurysms. A statement for healthcare professionals from the stroke council of the American Heart Association. Circulation 2000;102:2300-8.
Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 2000;93:379-87.
Karhunen PJ. Neurosurgical vascular complications associated with aneurysm clips evaluated by post-mortem angiography. Forensic Sci Int 1991;51:13–22
MacDonald RL, Wallace MC, Kestle JRW. Role of angiography following aneurysm surgery. J Neurosurg 1993;79:826–32.
Martin NA, Bentson J, Vinuela F, et al. Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 1990;73:526–33.
Friedman JA, Kumar R: Intraoperative angiography should be standard in cerebral aneurysm surgery. BMC Surg 9:7, 2009.
Kivisaari RP, Porras M, Ohman J, Siironen J, Ishii K, HernesniemiJ: Routine cerebral angiography after surgery for saccular aneurysms: is it worth it? Neurosurgery 55:1015-1024, 2004.
Sindou M, Acevedo JC, Turjman F: Aneurysmal remnants after microsurgical clipping: classification and results from a prospective angiographic study (in a consecutive series of 305 operated intracranial aneurysms). Acta Neurochir (Wien) 140:1153-1159, 1998.
Siasios I, Kapsalaki EZ, Fountas KN: The role of intraoperative micro-Doppler ultrasound in verifying proper clip placement in intracranial aneurysm surgery. Neuroradiology 54:1109-1118, 2012.
Katz JM, Gologorsky Y, Tsiouris AJ, Wells-Roth D, Mascitelli J, Gobin YP, Stieg PE, Riina HA: Is routine intraoperative angiography in the surgical treatment of cerebral aneurysms justified? A consecutive series of 147 aneurysms. Neurosurgery 58:719-727; discussion 719-727, 2006.
Klopfenstein JD, Spetzler RF, Kim LJ, Feiz-Erfan I, Han PP, Zabramski JM, Porter RW, Albuquerque FC, McDougall CG, Fiorella DJ: Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment. J Neurosurg 100:230-235, 2004.
Sasaki T, Kodama N, Matsumoto M, Suzuki K, Konno Y, Sakuma J, Endo Y, Oinuma M: Blood flow disturbance in perforating arteries attributable to aneurysm surgery. J Neurosurg 107:60-67, 2007.
Neuloh G, Schramm J. Monitoring of motor evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurosurg 2004;100:389–99.
Stendel R, Pietila T, Al Hassan AA, et al. Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurol Neurosurg Psychiatry 2000;68:29–35.
E.Z. Kapsalaki a, G.P. Lee b, J.S. Robinson III c, A.A. Grigorian d, K.N. Fountas d,The role of intraoperative micro-Doppler ultrasound in verifying proper clip placement in intracranial aneurysm surgery. Journal of Clinical Neuroscience 15 (2008) 153–157
Marchese E, Albanese A, Denaro L, et al. Intraoperative microvascular Doppler in intracranial aneurysm surgery. Surg Neurol2005;63:336–42
Bailes J, Tantuwaya LS, Fukushima T, et al. Intraoperative microvascular Doppler sonography in aneurysm surgery. Neurosurgery 1997;40:965–72.
Neuloh G, Schramm J. Monitoring of motor evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurosurg 2004;100:389–99.
Firsching R, Synowitz HJ, Hanebeck J. Practicability of intraoperative microvascular Doppler sonography in aneurysm surgery. Minim Invas Neurosurg 2000;43:144–8.
Weir B. Unruptured intracranial aneurysms: A review. J Neurosurg. 2002; 96:3–42. [PubMed: 11794601].
Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. Unruptured intracranial aneurysms:Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003; 362:103–110. [PubMed: 12867109].
Bederson JB, Awad IA, Wiebers DO, Piepgras D, Haley EC, Brott T, et al. Recommendations for the management of patients with unruptured intracranial aneurysms. A statement for healthcare professionals from the stroke council of the American Heart Association. Circulation 2000;102:2300-8.
Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 2000;93:379-87.
Karhunen PJ. Neurosurgical vascular complications associated with aneurysm clips evaluated by post-mortem angiography. Forensic Sci Int 1991;51:13–22
MacDonald RL, Wallace MC, Kestle JRW. Role of angiography following aneurysm surgery. J Neurosurg 1993;79:826–32.
Martin NA, Bentson J, Vinuela F, et al. Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 1990;73:526–33.
Friedman JA, Kumar R: Intraoperative angiography should be standard in cerebral aneurysm surgery. BMC Surg 9:7, 2009.
Kivisaari RP, Porras M, Ohman J, Siironen J, Ishii K, HernesniemiJ: Routine cerebral angiography after surgery for saccular aneurysms: is it worth it? Neurosurgery 55:1015-1024, 2004.
Sindou M, Acevedo JC, Turjman F: Aneurysmal remnants after microsurgical clipping: classification and results from a prospective angiographic study (in a consecutive series of 305 operated intracranial aneurysms). Acta Neurochir (Wien) 140:1153-1159, 1998.
Siasios I, Kapsalaki EZ, Fountas KN: The role of intraoperative micro-Doppler ultrasound in verifying proper clip placement in intracranial aneurysm surgery. Neuroradiology 54:1109-1118, 2012.
Katz JM, Gologorsky Y, Tsiouris AJ, Wells-Roth D, Mascitelli J, Gobin YP, Stieg PE, Riina HA: Is routine intraoperative angiography in the surgical treatment of cerebral aneurysms justified? A consecutive series of 147 aneurysms. Neurosurgery 58:719-727; discussion 719-727, 2006.
Klopfenstein JD, Spetzler RF, Kim LJ, Feiz-Erfan I, Han PP, Zabramski JM, Porter RW, Albuquerque FC, McDougall CG, Fiorella DJ: Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment. J Neurosurg 100:230-235, 2004.
Sasaki T, Kodama N, Matsumoto M, Suzuki K, Konno Y, Sakuma J, Endo Y, Oinuma M: Blood flow disturbance in perforating arteries attributable to aneurysm surgery. J Neurosurg 107:60-67, 2007.
Neuloh G, Schramm J. Monitoring of motor evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurosurg 2004;100:389–99.
Stendel R, Pietila T, Al Hassan AA, et al. Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurol Neurosurg Psychiatry 2000;68:29–35.
E.Z. Kapsalaki a, G.P. Lee b, J.S. Robinson III c, A.A. Grigorian d, K.N. Fountas d,The role of intraoperative micro-Doppler ultrasound in verifying proper clip placement in intracranial aneurysm surgery. Journal of Clinical Neuroscience 15 (2008) 153–157
Marchese E, Albanese A, Denaro L, et al. Intraoperative microvascular Doppler in intracranial aneurysm surgery. Surg Neurol2005;63:336–42
Bailes J, Tantuwaya LS, Fukushima T, et al. Intraoperative microvascular Doppler sonography in aneurysm surgery. Neurosurgery 1997;40:965–72.
Neuloh G, Schramm J. Monitoring of motor evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurosurg 2004;100:389–99.
Firsching R, Synowitz HJ, Hanebeck J. Practicability of intraoperative microvascular Doppler sonography in aneurysm surgery. Minim Invas Neurosurg 2000;43:144–8.
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Publicado
2018-06-07
Cómo citar
Rodriguez, S., & Cortes, W. (2018). Utilidad del micro doppler intraoperatorio en el clipaje de aneurismas cerebrales: Experiencia en el Hospital Infantil Universitario de San José. Neurociencias Journal, 24(3), 215–222. https://doi.org/10.51437/nj.v24i3.20
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