Method for determining adductor blood vessel in cerebral arteriovenous malformation

FIELD: medicine.

SUBSTANCE: method involves carrying out location measurements using transducer of 7.5 L in B mode, color dopplerometry mapping mode and in D mode. When obtaining an image characterized by anechogenic elongated formation having echogenic banding in B mode, high speed flow image with blood circulation directed towards the arteriovenous malformation in color dopplerometry mapping mode and bypass pattern image with high systolic and diastolic blood circulation speed and low pulsation index and resistance index values in D mode, adductor blood vessel in cerebral arteriovenous malformation is verified when having all the images located at the same place.

EFFECT: high reliability and accuracy of diagnosis.

9 dwg

 

The invention relates to medicine, namely surgery of cerebral vessels, and can be used when carrying out surgical procedures for the removal of arteriovenous malformations (AVM) of the brain.

There is a method of determining the leading vessel of the AVM by angiographic studies (Samotokin B.A., Khilko V.A. Aneurysm and arteriovenous fistula brain. HP: Medicine, 1973. - 288 S.). Make a puncture of an artery is injected contrast agent followed by a series of x-rays, which determine the position of the leading vessel of the AVM.

The disadvantages of the method include the inability to use it when conducting operations on an open brain as it requires special equipment for its implementation; the need for artery puncture with injection of a contrast agent, which has a negative effect on the entire body (allergic reactions) and directly on the vessel (angiospasm; radiation load on the patient.

There is a method of determining the leading vessel AVM of the brain by magnetic resonance imaging in combination with magnetic resonance angiography (Choline A. C. Magnetic resonance imaging in diseases of the Central nervous system. A guide for physicians, SPb.: Hippocrates, 1999. - 192 S.). Sposobov on obtaining a still image or moving units on the basis of the phenomenon of nuclear magnetic resonance. The method allows to identify the position of the leading vessel of the AVM in relation to the basic structures of the brain. The method is widely used in the preoperative diagnosis.

The disadvantages of this method are: it is challenging to use when conducting operations on an open brain as it requires special equipment for it; the resulting image reflects the position of the pathological education at the time of the study, and not at the time of surgery.

Closest to the claimed method is determining the leading vessel of the AVM by Doppler adopted for the prototype (Hassler W. Hemodynamic aspests of cerebral angiomas.//Acta Neurochir. 1986. - Vol.37, Suppl. - p.108-125). The method is based on the use of the Doppler effect in ultrasonic location of blood flow in the vessel microvascular sensor with a frequency of 16 or 20 MHz. Record the velocity of the blood flow with the already selected vessel after separation of education. Leading vessel is characterized by a pattern shunt with increased value and systolic and diastolic blood flow velocity with reduced values pulsating index and index resistivity.

The disadvantages of the prototype are: trauma, as it would require extensive osteoplastic craniotomy with a wide exposure of the brain to identify all the of Ferento and efferents, that is accompanied by bleeding from small arteries with dirty walls; the method can be applied only after the selection of the AVM from scarring and adhesions and allows you to get the resulting image of the vessel, and based only on the determination of the speed characteristics of the blood flow. In addition, microvascular sensor has low wear resistance and a high probability of failure during the operation.

The invention is directed to a method of determining the leading vessel of the AVM that reduce the trauma of the brain.

This technical result in the implementation of the invention is achieved in that in the known method of determining the leading vessel arteriovenous malformation of the brain by ultrasonic location in D mode, the peculiarity lies in the fact that additionally carry out location in the mode and color Doppler mapping (DDC), and all studies are carried out intraoperatively, and upon receipt of the image, characterized anechoic mass with the formation of oblong form with hyperechoic the striation in mode, high-speed flow with the direction of blood flow in the direction of arteriovenous malformations in DDC mode, pattern shunt with high systolic and diastolic velocity is of robotica with reduced values pulsating index and index resistivity in D mode in the same place, will verify leading vessel arteriovenous malformation of the brain.

The method is as follows. The study was conducted intraoperatively using ultrasonic device with sensor 7.5l, allowing you to get the image in mode, mode, color Doppler mapping (DDC) and D mode. Ultrasonic location is carried out after craniotomy through the Dura to her opening and before maningrida and encephalosis and highlight the leading vessel of the AVM from the rough adhesions in two mutually perpendicular planes from different points of view. Using and DRC modes define landmarks for navigation, which are the ventricles of the brain, the bones of the skull base and other clearly differentiable structure. For ease of interpretation of the image and the orientation of structures in the brain in the beginning it is advisable to use a plane close to the standard. Further, by changing the angle of the sensor itself is rendered pathological education. Mode DRC body AVM presents education with high-speed multi-directional flows.

If mode in the immediate vicinity of the body of the AVM renders a specific picture anechoic mass with education oblong form with hyperechoic the striation, the DRC that W is the place lazerette high speed flow with the direction of blood flow in the direction of the AVM. In D mode is determined by the pattern of the shunt, which is characterized by a high value and systolic and diastolic blood flow velocity with reduced values pulsating index and index resistivity, the combination of all three components allows to verify the leading vessel of the AVM. The location will determine the place of opening of the Dura and encephalocoele, floors leading vessel.

The method allows to determine the position of the leading vessel of the AVM in real time in relation to surrounding structures before opening of the Dura and its selection.

The inventive method developed in SE the Polenov research neurosurgical Institute them. Professor and Operated and clinically tested in the survey 3 patients.

Here is an example extract from the history.

Patient K., aged 23, IB 88-04, was treated In the Polenov research neurosurgical Institute with a diagnosis of AVM left parietal and temporal lobes.

Conducted angiographic examination. Identified the presence of AVM deep divisions left parietal and temporal lobes. Leading vessel branch of the left middle cerebral artery, which is indicated by the arrow (Figure 1).

Before the operation, 28.01.2004, patients received ultrasound through a bony defect in the skull. In mode is visualized specific picture anechoic mass with education predolgoj is the form with hyperechoic the striation, to set the pointer (Figure 2). Mode DRC on the place of education lazerette high speed flow with the direction of blood flow in the direction of arteriovenous malformations. Leading the vessel is indicated by a white arrow (Figure 3). In D mode Lazarova pattern shunt. PI=0,53, RI=0,43, Vsist=95 cm/s, Vdiast=54 cm/s (Fig 4).

29.01.2004 surgery: removal of the AVM left temporal lobe and parietal lobe.

During the operation, according to the present method, during the operation through a bony defect in the skull produced ultrasonic sonar sensors 5,0 P and 7.5 L in the mode of the DRC. Determined position of the body AVM, which is represented by the formation of a high-speed multi-directional flows (Figure 5). Lazarova leading vessel in the form of an anechoic mass with education oblong form with hyperechoic the striation in the mode that is indicated by the arrow (6). In DDC mode at the same location Lazarova high-speed stream directed to the body of the AVM. Leading the vessel is indicated by the arrow (7). In D mode, the flow in the formation is characterized by a pattern of shunt PI=0,38, RI=0,33, Vsist=91 cm/s, Vdiast=61 cm/s (Fig). On the basis of the obtained results verified the leading vessel AVM, its location in the substance of the brain. By ultrasound produced arcuate dissection of the Dura mater, below the projection AVM made available is to AVM. On the leading vessel imposed temporary clips. AVM was completely removed. The size and shape of the AVM coincided with the data of the ultrasound examination. Presents a photograph of the remote AVM (Fig.9).

The use of the claimed method allowed to detect the leading position of the vessel AVM, hold select and delete AVM with minimal trauma to brain tissue.

The method of determining the leading vessel arteriovenous malformation of the brain, including intraoperative ultrasound location in D mode, characterized in that the study was conducted with Dura additionally provide the location in the B-mode and color Doppler mapping (DDC) and upon receipt of the image, characterized anechoic mass with the formation of oblong form with hyperechoic the striation in b-mode, high-speed flow with the direction of blood flow in the direction of arteriovenous malformations in DDC mode, pattern shunt with high systolic and diastolic blood flow velocity with reduced values pulsating index and index resistivity in D-mode and the combination of all three images in the same place the vessel arteriovenous malformations and brain determine the cause.



 

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