The Guidance of Intraoperative Ultrasonography in the Surgical Treatment of Arteriovenous Malformation

Abstract

In this operative case-based report, we have investigated the ability and benefits of intraoperative grey-scale sonographic examination in the localising of arteriovenous malformations in the brain, the identification of feeding artery or arteries, the description of perilesional changes, and the detection of accompanying hematomas. The surrounding edematous brain tissue was observed as hyperechioc areas. The arteriovenous malformation appeared in two echogenic parts, a hyperechioc thrombotic part and a hypoechoic perfused part. We were able to identify the feeding artery. The sonographic characteristics of this artery are thick vascular wall, the presence of arterial systolic pulsation and a close relation with the nidus. We conclude that intraoperative ultrasonographic examination during the surgical treatment of arteriovenous malformation is a non-invasive, useful, and simple diagnostic tool in the detection of the components and accompanying parts of the lesion.

Key words

Surgical treatment - arteriovenous malformations - intraoperative ultrasonography

References

• 1 Al-Shari R, Warlow C. A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults.  Brain. 2001;  124 1900-1926
• 2 Ohaegbulam S C. The epidemiology of brain arteriovenous malformations.  Neurosurgery. 2001;  49 226-228
• 3 Auer L M, van Velthoven V. Intraoperative ultrasound (US) imaging. Comparison of pathomorphological findings in US and CT.  Acta Neurochir (Wien). 1990;  104 84-95
• 4 Brownbill D. The clinical value of echoencephalography.  Aust NZ J Surg. 1970;  40 74-78
• 5 Glasauer F E, Schlagenhauff R E. The use of intraoperative echoencephalography.  Neurology. 1970;  20 1103-1107
• 6 Gronningsaeter A, Unsgard G, Ommedal S, Angelsen B A. Ultrasound-guided neurosurgery: a feasibility study in the 3 - 30 MHz frequency range.  Br J Neurosurg. 1996;  10 161-168
• 7 Hammoud M A, Ligon B L, elSouki R, Shi W M, Schomer D F, Sawaya R. Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging.  J Neurosurg. 1996;  84 737-741
• 8 Knake J E, Bowerman R A, Silver T M, McCracken S. Neurosurgical applications of intraoperative ultrasound.  Radiol Clin North Am. 1985;  23 73-90
• 9 Kumar P, Sukthankar R, Damany B J, Mishra J, Jha A N. Evaluation of intraoperative ultrasound in neurosurgery.  Ann Acad Med Singapore. 1993;  23 422-427
• 10 Quencer R M, Montalvo B M. Intraoperative cranial sonography.  Neuroradiology. 1986;  28 528-550
• 11 Szczerbicki M, Jarek K, Kozlowski J. Intraoperative ultrasonography of brain tumors.  Neurol Neurochir Pol. 1996;  30 831-838
• 12 Tada M, Kaneko S, Imai T, Abe H, Tsuru M, Shirato H, Chohgi K. Intraoperative sonography for brain tumor surgery.  Hokkaido Igaku Zasshi. 1985;  60 82-90
• 13 Bohinski R J, Kokkino A K, Warnick R E, Gaskill-Shipley M F, Kormos D W, Lukin R R, Tew jr J M. Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection.  Neurosurgery. 2001;  48 731-742
• 14 Dulou R, DeSoultrait F, Blondet E, Dutertre G, Pernot P, Desgeorges M. Neuronavigation in third ventricle tumors.  Neurochirurgie. 2000;  46 282-285
• 15 Fahlbusch R, Ganslandt O, Nimsky C. Intraoperative imaging with open magnetic resonance imaging and neuronavigation.  Childs Nerv Syst. 2000;  16 829-831
• 16 Gumprecht H K, Widenka D C, Lumenta C B. BrainLab VectorVision Neuronavigation System: technology and clinical experiences in 131 cases.  Neurosurgery. 1999;  44 97-104
• 17 Liu H, Hall W A, Martin A J, Maxwell R E, Truwit C L. MR-guided and MR-monitored neurosurgical procedures at 1.5 T.  J Comput Assist Tomogr. 2000;  24 909-918
• 18 Matula C, Rossler K, Reddy M, Schindler E, Koos W T. Intraoperative computed tomography guided neuronavigation: concepts, efficiency, and work flow.  Comput Aided Surg. 1998;  3 174-182