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Gulino V, Brunasso L, Avallone C, Campisi BM, Bonosi L, Costanzo R, Cammarata E, Sturiale CL, Cordova A, Iacopino DG, Maugeri R. The Use of Intraoperative Microvascular Doppler in Vascular Neurosurgery: Rationale and Results-A Systematic Review. Brain Sci 2024; 14:56. [PMID: 38248271 PMCID: PMC10813139 DOI: 10.3390/brainsci14010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Surgical treatment of neurovascular lesions like intracranial aneurysms, arteriovenous malformations and arteriovenous dural fistulas is still associated with high morbidity. Several recent studies are providing increasing insights into reliable tools to improve surgery and reduce complications. Inadvertent vessel compromise and incomplete occlusion of the lesion represent the most possible complications in neurovascular surgery. It is clear that direct visual examination alone does not allow to identify all instances of vessel compromise. Various modalities, including angiography, microvascular Doppler and neurophysiological studies, have been utilized for hemodynamics of flow vessels in proper clipping of the aneurysm or complete obliteration of the lesion. We intended to review the current knowledge about the intraoperative microvascular Doppler (iMDS) employment in the most updated literature, and explore the most recent implications not only in intracranial aneurysms but also in neurovascular lesions like arteriovenous malformations (AVMs) and arteriovenous dural fistulas (AVDFs). According to the PRISMA guidelines, systematic research in the most updated platform was performed in order to provide a complete overview about iMDS employment in neurovascular surgery. Twelve articles were included in the present paper and analyzed according to specific research areas. iMDS employment could represent a crucial tool to improve surgery in neurovascular lesions. The safety and effectiveness of the surgical treatment of neurovascular lesions like intracranial aneurysm and other neurovascular lesions like AVMs and AVDFs requires careful and accurate consideration regarding the assessment of anatomy and blood flow. Prognosis may depend on suboptimal or incomplete exclusion of the lesion.
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Affiliation(s)
- Vincenzo Gulino
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Lara Brunasso
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Chiara Avallone
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Benedetta Maria Campisi
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Lapo Bonosi
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Roberta Costanzo
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Emanuele Cammarata
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (E.C.); (A.C.)
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy;
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (E.C.); (A.C.)
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
| | - Rosario Maugeri
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy; (V.G.); (L.B.); (C.A.); (B.M.C.); (L.B.); (R.C.); (R.M.)
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Liang B, Feng D, Lyon KA, Zhang Y, Huang JH. Intraoperative utilization of Microvascular Doppler for the detection of intracranial venous structures during tumor resection - A technical note. J Clin Neurosci 2021; 88:10-15. [PMID: 33992166 DOI: 10.1016/j.jocn.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Microvascular Doppler (MVD) has been widely used for the detection of arterial blood flow in the brain, especially during aneurysm clipping, vascular malformation resection, or bypass surgeries. However, the benefits obtained from early identification of intracranial sinuses and deep draining veins during tumor resection has not been reported. METHODS We reviewed the clinical data and imaging from our cases and conducted a systemic review of the medical literature using PubMed and keywords. Bibliographies of each result were evaluated to determine if additional reports describing the use of MVD during tumor resection could be found. RESULTS No reports were found in the literature where MVD was specifically used for venous identification during the resection of deep-seated brain tumors. In our patient cohort, MVD was used successfully to detect and ultimately allow immediate protection of large dural venous sinuses as well as smaller deep cerebral veins during tumor resection. Each patient developed no new venous infarcts and made a satisfactory recovery with no new postoperative neurological deficits. CONCLUSION MVD is a reliable tool for the intraoperative detection of intracranial venous blood flow to allow for quick identification and protection of venous structures. MVD is an additional safety measure for the patient as its accuracy in detecting venous structures is less susceptible to many of the inherent weaknesses of stereotactic neuro-navigation including the accompanying brain shift or anatomical distortion produced by long duration deep seated brain tumor resection.
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Affiliation(s)
- Buqing Liang
- Department of Neurosurgery, Baylor Scott & White Health, Scott & White Medical Center, Temple, TX, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| | - Dongxia Feng
- Department of Neurosurgery, Baylor Scott & White Health, Scott & White Medical Center, Temple, TX, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| | - Kristopher A Lyon
- Department of Neurosurgery, Baylor Scott & White Health, Scott & White Medical Center, Temple, TX, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| | - Yilu Zhang
- Department of Neurosurgery, Baylor Scott & White Health, Scott & White Medical Center, Temple, TX, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Scott & White Medical Center, Temple, TX, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA.
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