INTRAOPERATIVE DUPLEX SONOGRAPHY FOR THE TREATMENT OF LARGE AND GIANT ANEURYSMS. RETROSPECTIVE ANALYSIS OF 13 CASES

Object: The aim of the study was to evaluate the usefulness of intraoperative duplex sonography in the treatment of large (17-24 mm) and giant (>25mm) intracranial aneurysms.
Methods: A Retrospective clinical review of 13 cases of giant and large aneurysms treated in Tokuda Hospital Sofia, Bulgaria. Results: The preoperative location of the aneurysm was as follows: MCA 6 pts (46%), ICA -5 pts (38%), ICA-Ophthalmic 1pt (8%) AcomA – 1pt (8%). Intraoperative Ultrasound (IOUS) was used in all of the cases for intraoperative visualization of the aneurysm, adequate clip position. Endoscopy was applied additionally in 4 of the cases (31%). The IOUS visualization of distal blood flow was achieved in 4 out of 13 patients (30%). Due to the IOUS image clip reposition was done in 1 pt (8%). In 10 pts (77%), clipping of the aneurysm was performed, and 3 cases (23%) the aneurysms were treated by wrapping. On postoperative CTA controls, complete aneurysm obliteration was observed in all clipped patients. In 3 (23%) patients under IOUS guidance, the aneurysmal walls were reduced in size using bipolar coagulation with the further good presentation of the aneurysmal neck, which allowed adequate clip placement.
Conclusion: The initial experience with this technique indicates that it is a reliable tool for blood flow evaluation in large and giant aneurysms, as well as the presence of intraluminal thrombosis and calcifications in the aneurysm wall. The data from IOUS facilitates a more secure microsurgical dissection and in some situations gives additional data needed for clip repositioning and intraoperative diagnosis. The combination of IOUS and endoscopy provides additional information, which could aid the management of these lesions.