Insonation angle impact on micro-Doppler evaluation in cerebrovascular surgery: technical note
DOI:
https://doi.org/10.55005/v3i1.9Keywords:
micro-Doppler, insonation angle, cerebrovascular surgeryAbstract
Introduction: The insonation angle consideration is important in the Doppler-sonographic evaluation of blood flow velocities and volume, however, the concept is rarely applied to the intraoperatively used micro-Doppler.
This technical note aims to emphasize the possibility and necessity of insonation angle correction and preservation for the blood flow assessment in cerebrovascular surgery.
Methods: Bi-directional surgical Doppler with a 20MHz flexible bayonet 1.2mm diameter probe was used for the intraoperative blood flow assessment, with the variable insonation angle on the straight parts of the arteries, and the results were recorded to demonstrate the importance.
Results: The measurements performed confirmed that the blood flow features, including the direction, velocity, and especially the volume, are highly susceptible to the insonation angle variations. Although there were significant alterations, positioning the probe at an angle of ~60 degrees resulted in the variable but less altering measurements.
Conclusion: Positioning the probe at ~60 degrees is desirable; however, it appears that it is even more important to maintain the same insonation angle and probe position when assessing the vessels repeatedly for blood flow alterations that might occur in the course of cerebrovascular surgery.
References
Dubovoy A, Lekchnov E, Galaktionov D, Ovsyannikov K, Bervitskiy A, Sosnov A, et al. Microsurgical management of complex middle cerebral artery aneurysms. Neurohirurgija - The Serbian Journal of Neurosurgery. 2021;1(1). doi: 10.55005/sjns.v1i1.2.
Firsching R, Synowitz HJ, Hanebeck J. Practicability of intraoperative microvascular Doppler sonography in aneurysm surgery. Minim Invasive Neurosurg. 2000;43(3):144-8. doi: 10.1055/s-2000-12261.
Cui H, Wang Y, Yin Y, Wan J, Fei Z, Gao W, et al. Role of intraoperative microvascular Doppler in the microsurgical management of intracranial aneurysms. J Clin Ultrasound. 2011;39(1):27-31. doi: 10.1002/jcu.20751.
Morisawa H, Kawamata T, Kawashima A, Hayashi M, Yamaguchi K, Yoneyama T, et al. Hemodynamics and changes after STA-MCA anastomosis in moyamoya disease and atherosclerotic cerebrovascular disease measured by micro-Doppler ultrasonography. Neurosurg Rev. 2013;36(3):411-9. doi: 10.1007/s10143-012-0441-y.
Burkhardt T, Siasios G, Schmidt NO, Reitz M, Regelsberger J, Westphal M. Intraoperative Micro-Doppler in Cerebral Arteriovenous Malformations. J Neurol Surg A Cent Eur Neurosurg. 2015;76(6):451-5. doi: 10.1055/s-0035-1551829.
Krejza J, Mariak Z, Babikian VL. Importance of angle correction in the measurement of blood flow velocity with transcranial Doppler sonography. AJNR Am J Neuroradiol. 2001;22(9):1743-7. doi:
Lepic T, Veljancic D, Jovanikic O, Lepic M, Slankamenac P, Raicevic R. Importance of angle correction in transcranial color-coded duplex insonation of arteries at the base of the brain. Vojnosanit Pregl. 2015;72(12):1093-7. doi: 10.2298/vsp141105009l.
Eicke BM, Tegeler CH, Dalley G, Myers LG. Angle correction in transcranial Doppler sonography. J Neuroimaging. 1994;4(1):29-33. doi: 10.1111/jon19944129.
Bartels E, Flugel KA. Quantitative measurements of blood flow velocity in basal cerebral arteries with transcranial duplex color-flow imaging. A comparative study with conventional transcranial Doppler sonography. J Neuroimaging. 1994;4(2):77-81. doi: 10.1111/jon19944277.
Lepić M. Intraoperative ultrasound use in cranial neurosurgery: The basics and initial experience. Neurohirurgija - The Serbian Journal of Neurosurgery. 2022;1(1):39-44. doi: 10.55005/sjns.v1i1.4.
Malinova V, von Eckardstein K, Rohde V, Mielke D. Neuronavigated microvascular Doppler sonography for intraoperative monitoring of blood flow velocity changes during aneurysm surgery - a feasible monitoring technique. Clin Neurol Neurosurg. 2015;137:79-82. doi: 10.1016/j.clineuro.2015.06.021.
Bhave VM, Stone LE, Rennert RC, Steinberg JA. Complementary Tools in Cerebral Bypass Surgery. World Neurosurg. 2022;163:50-9. doi: 10.1016/j.wneu.2022.03.146.
Revzin MV, Imanzadeh A, Menias C, Pourjabbar S, Mustafa A, Nezami N, et al. Optimizing Image Quality When Evaluating Blood Flow at Doppler US: A Tutorial. Radiographics. 2019;39(5):1501-23. doi: 10.1148/rg.2019180055.
Klünemann HH, Arnolds BJ, von Reutern GM. Angle dependence and transit time effect in Doppler flow measurement. European Journal of Ultrasound. 1996;3(3):261-6. doi: 10.1016/0929-8266(95)00158-n.
Nickele C, Nguyen V, Fisher W, Couldwell W, Aboud E, David C, et al. A Pilot Comparison of Multispectral Fluorescence to Indocyanine Green Videoangiography and Other Modalities for Intraoperative Assessment in Vascular Neurosurgery. Operative Neurosurgery. 2019;17(1):103-9. doi: 10.1093/ons/opy237.
Oglat AA, Matjafri MZ, Suardi N, Oqlat MA, Abdelrahman MA, Oqlat AA. A Review of Medical Doppler Ultrasonography of Blood Flow in General and Especially in Common Carotid Artery. J Med Ultrasound. 2018;26(1):3-13. doi: 10.4103/jmu.Jmu_11_17.
Alexandrov AV, Sloan MA, Wong LK, Douville C, Razumovsky AY, Koroshetz WJ, et al. Practice standards for transcranial Doppler ultrasound: part I--test performance. J Neuroimaging. 2007;17(1):11-8. doi: 10.1111/j.1552-6569.2006.00088.x.
Siasios I, Kapsalaki EZ, Fountas KN. The role of intraoperative micro-Doppler ultrasound in verifying proper clip placement in intracranial aneurysm surgery. Neuroradiology. 2012;54(10):1109-18. doi: 10.1007/s00234-012-1023-y.
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