Intraoperative Doppler ultrasonography and ultrasound angiography in operation for brain arteriovenous malformations

Abstract

To investigate the reliability and clinical value of intraoperative Doppler ultrasonography and ultrasound angiography in treatment of brain arteriovenous malformations (AVMs). We demonstrate the correlation between the change of resistive index (RI) of feeding artery and the completeness of resection of brain AVMs. Intraoperative Doppler ultrasonography was applied in 82 patients with intracranial brain AVMs undergoing resection, and ultrasound angiography was used in 15 of the 82 patients in addition. The resistive index (RI) of the feeding artery was recorded so as to identify the residual AVMs. Intraoperative angiography or postoperative angiography was performed in all patients. Intraoperative color Doppler ultrasonography clearly identified the position, size, and flow characteristics of AVMs by showing double colors and directions of flow pattern, the feeding arteries, and draining veins. The mean pre-resection RI of the feeding artery was (0.37 +/- 0.08), and the post-resection RI was (0.63 +/- 0.09) (P < 0.05). In 8 cases the AVMs were translocated the translocation so they needed localized and delineated again. In 7 cases residual AVMs were suspected intraoperatively by ultrasonography and were confirmed by re-exploration and resected totally. Intraoperative Doppler ultrasonography is a reliable tool for intraoperative localization and complete resection of AVMs. Providing real-time flow pattern of AVMs, intraoperative ultrasound angiography combined with RI effectively indicates the completeness of resection of AVMs.