Intraoperative use of Doppler ultrasound and endoscopic monitoring in the stereotactic biopsy of malignant brain tumors. Technical note.
Intraoperative use of Doppler ultrasound and endoscopic monitoring in the stereotactic biopsy of malignant brain tumors. Technical note.
复制标题
术中使用多普勒超声和内窥镜监测对恶性脑肿瘤进行立体定向活检。
DOI：
10.3171/jns.1994.80.3.0570
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发表时间：
1994
影响因子：
4.1
通讯作者：
Masako Kawahara
中科院分区：
文献类型：
--
作者：
Toshiki Yamasaki;Kouzo Moritake;Mikio Takaya;T. Kagawa;H. Nagai;Y. Akiyama;Masako Kawahara
本文描述了一种术中监测工具，用于在立体定向手术中防止脑内血管的机械损伤。采用脉冲多普勒超声和纤维内镜相结合的方法，对25例高血管性恶性脑肿瘤、13例多形性胶质母细胞瘤、5例间变性星形细胞瘤、5例转移性肿瘤和2例恶性淋巴瘤患者进行了立体定向活检，无严重颅内出血。超声仪器有一个内置的快速傅立叶变换系统分析仪和一个改进的过滤系统，提供血液流速的实时测量。血流的来源（动脉或静脉）可以通过实时超声和声信号频率来识别。通过调整多普勒信号增益表盘从最初的渐强到渐弱的声音，可以测量血管的大小和距离，因为声学信号以0.1 mm的步骤调整到每个血管的轴向流。三个多普勒探头（直径1mm、2mm和3mm）中的每一个都穿过活检针的外套管。距离探针尖端7mm内的血管可以被轻松快速地检测到，因此活检针可以安全地以7mm的步骤推进到所需的目标。如果超声显示血流，表明在预定的立体定向轨迹中存在较大的血管，则稍微改变针头的角度以避免血管损伤。由于纤维内窥镜连接到视频处理器，除非有活动性出血，否则可以在视频显示器上以更高的放大倍数看到血管。这种技术简单可靠的系统在保持精度的同时提高了操作安全性。
An intraoperative monitoring tool is described that prevents mechanical injury to intracerebral vessels during stereotactic surgery. The method, which combines pulse Doppler ultrasonography and fiberendoscopy, allowed stereotactic biopsy to be performed without serious intracerebral bleeding in 25 patients with hypervascular malignant brain tumors, 13 with glioblastoma multiforme, five with anaplastic astrocytoma, five with metastatic tumor, and two with malignant lymphoma. The ultrasound apparatus has a built-in fast-Fourier transformation system analyzer and an improved filtering system that provide real-time measurement of blood flow velocity. The source of flow (arterial or venous) could be identified by both real-time sonography and acoustic signal frequencies. It was possible to measure the size and distance of a vessel by adjusting the Doppler signal gain dial from initially waxing to waning sounds, because the acoustic signal was adjusted to the axial flow of each vessel in 0.1-mm steps. Each of three Doppler probes (1 mm, 2 mm, and 3 mm in diameter) fit through the outer cannula of the biopsy needle. Vessels located within 7 mm from the tip of these probes could be detected easily and rapidly, so the biopsy needle could be advanced safely to the desired target in 7-mm steps. If sonograms revealed blood flow, indicating the presence of larger vessels in the intended stereotactic trajectory, the angle of the needle was changed slightly to avoid vascular injury. Because the fiberendoscope was connected to a video processor, the vessel could be visualized at a higher magnification on the video display, unless there was active bleeding. This technically simple and reliable system enhances operative safety while maintaining accuracy.