INTRAOPERATIVE COLOR DUPLEX SONOGRAPHY OF BASAL ARTERIES DURING ANEURYSM SURGERY

This prospective study aimed at (1) characterizing the duplex sonograp hic appearance of cerebral aneurysms, (2) visualizing their location, and (3) ensuring the complete occlusion of the aneurysm as well as the patency of the basal arteries during aneurysm surgery. During 9 month s 30 craniotomies for aneurysm clipping in 29 patients were monitored intraoperatively by B-mode and color-coded duplex sonography. Followin g craniotomy the aneurysm and the preaneurysmatic and postaneurysmatic arteries were sonographically visualized before and after clipping an d removal of the spatulas. Twenty-seven (90%) of 30 aneurysms appeared as a hypoechoic structure. Together with the typical dichromatic pict ure in the color mode and the characteristic bidirectional flow patter n in the duplex mode, 29 (97%) of 30 aneurysms were identified and loc alized anatomically correctly. Eighty (99%) of 81 relevant vessels wer e visualized and measured with the Doppler mode. After clipping, flow was detectable in all major arteries except 3 middle cerebral artery ( MCA) branches. In 1, occlusion was confirmed by postoperative angiogra phy. In the other 2, early postoperative computed tomography showed an infarction of the corresponding MCA territories. This study demonstra ted the potential of color duplex sonography to visualize and characte rize cerebral aneurysms and adjacent basal arteries before and after c lipping. It offers a noninvasive intraoperative method to control the patency of basal arteries and complete occlusion of the aneurysm.