Impacto da introdução do microdoppler vascular para a avaliação do fluxo sanguíneo cerebral durante a microcirurgia de aneurismas intracranianos

Abstract

In vascular microsurgery, the clipping of intracranial aneurysms may result in partial or complete occlusion of the parental artery, resulting in ischemic infarction. Methods that analyze cerebral blood flow during this procedure are essential to prevent those complications. The use of Ultrassom Doppler (USD) to assess vascular hemodynamics of vessels and aneurysms before and after clipping presents good results compared to the gold-standard technique, intraoperative angiography. Objective: To analyze the impact of the MD introduction, as a method of analysis of cerebral blood flow during microsurgery of intracranial aneurysms by checking the partial occlusion of the aneurysm and the occurrence of stenosis, comparing these results with those provided by the postoperative digital subtraction angiography (DSA), and the occurrence of ischemic infarction on the postoperative computerized tomography (CT) images. Patients and Methods: We reviewed retrospectively the last 50 patients operated on before the introduction of the MD compared to the first 50 patients operated on using this technique. All patients underwent pre and postoperative DSA to analyze the occurrence of residual aneurysms and the occlusion of parental arteries, as well as pre and postoperative CT to assess the incidence of ischemic infarction, postoperatively. Results: CT findings: 9 (18%) of the 50 patients evaluated in the group where the MD was not used showed hypodensity in the postoperative CT images, while only 2 patients showed infarction in the group in which the MD was used (p = 0.02). Regarding the postoperative angiography findings, the results were as follows: in the group in which the MD was not used, 10 patients presented unexpected findings (residual aneurysms, stenosis and arterial occlusion); whereas in the group in which the MD was used, those unexpected findings were observed in only 3 patients (p = 0.023). Conclusion: The MD was an excellent method for cerebral blood flow assessment during the microsurgery of intracranial aneurysms, reducing the unexpected angiographic results (residual aneurysms, stenosis and arterial occlusion), as well as reducing the incidence of ischemic infarction on postoperative CT images, when compared with the group where this method was not used, evidencing a positive impact of this method in the treatment of intracranial aneurysms.