The value of transcranial duplex sonography in the management of patients subsequent to surgery for middle cerebral artery aneurysms.
OBJECTIVE
We intended to evaluate the value of transcranial color-coded duplex sonography (TCCS) in the management of patients after clipping of an aneurysm of the middle cerebral artery. Question was whether this method was able to predict poor clinical outcome by detection of local circulation disorders in the postoperative course.


METHODS
A series of 15 consecutive patients was examined daily by TCCS. Special attention was paid to the branches of the middle cerebral artery distal from the clip (M2 branches). We correlated the TCCS results to the clinical outcome and occurrence of infarction on CCT.


RESULTS
In six patients, one or more M2 branches could not be found in the immediate postoperative course, but reappeared after a period of 1-12 days in five patients. The three patients with a missing signal for more than 4 days suffered from infarction of the dependent territory and permanent neurological deficit not due to vasospasm of the middle cerebral artery. In the nine patients with constant TCCS signals, there was only one infarction due to pre-hospital systemical hypotension.


CONCLUSIONS
TCCS cannot give exact postoperative information about incidental vessel occlusion during surgery for MCA aneurysms because M2 branches can remain invisible for some days without being occluded, but this invisibility seems to be coupled with ischemic complications.
Mursch
K
K
Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany. juliatkay@aol.com
Enk
T
T
Markakis
E
E
D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D002560:Cerebrovascular Circulation; D005069:Evaluation Studies as Topic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D018616:Ultrasonography, Doppler, Duplex; D017585:Ultrasonography, Doppler, Transcranial