Introduction: The outcome of surgical treatment of cerebral aneurysms may be severely impaired by local cerebral ischaemia, or by infarction resulting from the inadvertent occlusion of an adjacent vessel. Incomplete aneurysm occlusion, on the other hand, increases the risk of haemorrhage. It is therefore of the utmost importance that both aneurysm occlusion and inadvertent clipping of neighbouring vessels be avoided during the surgical act.
Methods: We conducted a retrospective analysis of 92 patients with a total of 101 intracranial aneurysms,who were evaluated with intraoperative microvascular Doppler (IMD). Blood flow velocities in the aneurysmal sac and in the parent artery were determined by IMD before and after aneurysm clipping. The findings of IMD were analysed and compared with those of visual inspection of the surgical site and of postoperative angiography. Analysis was also made of the cases in which the clip was repositioned due to IMD findings.
Results: The vascular murmur could be easily detected by IMD in all aneurysms. The findings of IMD helped in adjusting timely the clip placement. In 11 out of 101 (10.9%) aneurysms, IMD revealed a persistent weak blood flow spectrum through the aneurismal sac after clip application and the clip was repositioned. A relevant stenosis of the parent artery induced by clip positioning that had escaped detection by visual inspection was identified by IMD in 19 out of 101 (18.8%) aneurysms. Among paraclinoid or ophthalmic segment large or giant aneurysm were clipped with 2-3 clips and internal carotid artery was reshaped.
Conclusions: IMD could detect the cerebral hemodynamic changes with aneurysms and parent artery in noninvasive way. The clip could be repositioned on the basis of the IMD results. It is recommended that IMD be used routinely in aneurysm surgery, especially in those large and giant aneurysms with wide neck or without neck.
Patient Care: Qualitative analysis and quantitative analysis measurement of blood flow in cerebral vessels during aneurysm surgery can help prevent ischaemia and improve patient outcome. The present study was performed to investigate the reliability and practicability of intraoperative monitoring techniques during cerebral aneurysm surgery, and to assess the influence of this method on the surgical procedure.
Learning Objectives: The present study was performed to investigate the reliability and practicability of intraoperative microvascular Doppler (IMD) during cerebral aneurysm surgery, and to assess the influence of this method on the surgical procedure.