Advances and technical standards in neurosurgery
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Adv Tech Stand Neurosurg · Jan 1998
Clinical Trial Controlled Clinical TrialThe endovascular treatment of brain arteriovenous malformations.
Advances in superselective microcatheterization techniques, which took place in the past decade, established superselective endovascular exploration as an integral and indispensable tool in the pretherapeutic evaluation of brain AVMs. The strict and routine application of superselective angiography furthered our knowledge on the angioarchitecture of brain AVMs, including vascular composition of the nidus, types of feeding arteries and types and patterns of venous drainage. In addition, various types of weak angioarchitectural elements, such as flow-related aneurysms, intranidal vascular cavities and varix formation proximal to high-grade stenosis of draining veins, could be identified as factors predisposing for AVM rupture. ⋯ The strategy should include the definition of embolization targets, the selection of the most appropriate approach for endovascular navigation, the determination of the sequence of catheterization of individual feeding arteries, the selection of the type of catheters and microcatheters, the selection of the appropriate embolic materials as well as the site and mode of their delivery. Thereafter, every endovascular move should be, as in a chess game, the result of a logical plan. (3) Atraumatic superselective microcatheterization is a key point in the endovascular treatment of brain AVMs. It requires manual skills, knowledge of anatomy and respect for the vascular wall. (4) All locations of brain AVMs should be regarded as eloquent, and no distinction should be made between eloquent and non-eloquent areas of the brain when deciding on the execution of embolizatio
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This chapter describes the use of the transcranial Doppler apparatus in neurosurgery. The principles of Doppler insonation, the techniques of recording and the use of activation techniques is described. The relationship between blood flow and blood velocity is discussed, and the interaction of various pharmacological agents. ⋯ Cerebral vascular reactivity measurements and the interaction of Doppler recordings with raised intracranial pressure, useful in assessment of cerebral perfusion pressure as in head injury and in terminal cases, is documented. The use of transcranial Doppler in management of head injury and subarachnoid haemorrhage is described. The latter is probably the most useful routine place for Doppler measurement in neurosurgical practice and the documentation of the onset and progress of vasospasm is the final portion of the chapter.