Background: The use of directional intraoperative Doppler ultrasonography (dioDoppler) is well established as a tool in the surgery of intracranial aneurysms and cerebral arteriovenous malformations. The literature provides little information about the possible usefulness of this method during surgery on cranial dural arteriovenous fistulas (dAVFs).
Objective: To present our experience regarding the use of dioDoppler during surgery on cranial dAVFs.
Methods: All patients undergoing craniotomy for cranial dAVF during the time period January 2007 – October 2012 wherein dioDoppler was used were included in the study. We reviewed patient records, operating protocols, radiological images, dioDoppler files, and intraoperative videos.
Results: During the study period, 12 patients with cranial dAVFs underwent surgical treatment facilitated by dioDoppler. Four patients were operated on acutely for cerebral bleeds, while eight were treated due to various cerebral symptoms and the assumption of a significant risk for intracranial bleed. Three advantages of the dioDoppler were: (a) unequivocal identification of veins with cortical/deep venous reflux from the fistula, (b) verification of completeness of occlusion of the fistula, and (c) identification of dural arterial feeders not visualized under the microscope.
Conclusion: Reviewing our experience, we found that dioDoppler sonography is an easy, safe, effective, reliable and instantaneous tool during surgery on cranial dAVFs.
From: Directional Intraoperative Doppler Ultrasonography During Surgery on Cranial Dural Arteriovenous Fistulas by Eide et al.