The Effect And The Significance Of Intraoperative Microvascular Doppler Ultrasonography(IMD) In The Cerebral Aneurysm Clipping

Objective:To evaluate the effect and the significance of Intraoperative microvascular Doppler ultrasonography(IMD) in the cerebral aneurysm clipping.Methods:Select79cases of cerebral aneurysm surgery in July to November in2011at Sichuan Provincial People’s Hospital as the experimental group,use the IMD to detect the the blood flow velocity of aneurysm sac, adjacent vessels and parent arteries before and after the clipping. To evaluate the active guiding role of IMD for cerebral aneurysm surgery according to the effect of IMD in cerebral aneurysm surgery. And comparatively analyse outcome of cerebral aneurysm surgery without IMD by the same number of cases with the same period of2010by turn.Results:IMD found that the occlusion of adjacent vessels due to misclipping in the anterior cerebral artery (ACA) and anterior communicating artery (ACoA) aneurysm surgery was6.33%. The blood flow velocity changes greater than10%after clipping of aneurysm was15.19%,so the adjusting of intraoperative aneurysm clipping was the highest proportion,11.39%of the total number of cases;In the MCA aneurysm clipping operation, the occlusion of adjacent vessels due to misclipping was6.33%, The blood flow velocity changes greater than10%after clipping of aneurysm was11.39%, the adjusting of intraoperative aneurysm clipping was10.13%; The occlusion of adjacent vessels and blood flow velocity changes in the posterior communicating(PCoA) artery aneurysm surgery,1.27%and2.53%respectively, aneurysm clip to adjust probability of only1.27%;In large, complex aneurysm surgery,6patients were detected in the adjacent vessels occlusion or blood flow velocity changes must adjust the aneurysm clip; Preoperative Hunt-Hess grade Ⅲ-Ⅳ patients with aneurysm clip to adjust probability of18.99%, higher than8.86%of the patients with Ⅰ-Ⅱ class; Routine use IMD in aneurysm surgery,the postoperative hospital stay, the rate of surgery, the postoperative GOS, the complication rate was significantly better than the patients without IMD in aneurysm surgery..Conclusion:The routing ues of IMD in the cerebral aneurysm clipping can detect the inadvertent occlusion or incomplete closure due to perspective and the unknown local anatomy, conducive to the timely adjustment of aneurysm clip position, especially for the clinoid segment,ophthalmic artery segment, and a huge, complex aneurysms is particularly prominent role, and can significantly improve postoperative GOS score, shorter hospital stay, reoperation rate and reduce the risk of complications.