Cranioplasty and Duraplasty with Transcranial Color-Coded Duplex Sonography after Aneurysmal Subarachnoid Hemorrhage.
BACKGROUND
Transcranial color-coded duplex sonography (TCCS) is a noninvasive technique for monitoring of cerebral vasospasm after neurosurgery for aneurismal subarachnoid hemorrhage. In this surgery, surgical materials are used. The goal of the study was to identify materials that can be used with ultrasound and to propose methods for cranioplasty and duraplasty using materials that permit TCCS.


METHODS
The chosen neurosurgical materials were titanium mesh plate (TMP), Gore-tex, SEAMDURA, gelatinous sponge, and oxidized cellulose. B-mode imaging was recorded with the materials placed between urethane resin 10 mm in diameter and the urethane phantom model. TCCS was performed to detect middle cerebral artery flow through TMP and Gore-tex.


RESULTS
TMP and SEAMDURA permitted penetration of ultrasound in B-mode and Doppler imaging, but the other materials did not do so.


CONCLUSIONS
A postcraniotomy window (PCW) on a line extending from the horizontal portion of M1 using only TMP permitted flow imaging with TCCS. In external decompression, TCCS was effective only without use of Gore-tex around the postcraniotomy window. This method allows the middle cerebral artery flow to be detected easily.
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan. Electronic address: sadahiro@kenwakai.gr.jp.
Hirokazu
H
Sadahiro
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan.
Akinori
A
Inamura
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan.
Kazutaka
K
Sugimoto
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan.
Akiko
A
Yamane
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan.
Hideyuki
H
Ishihara
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan.
Satoshi
S
Shirao
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan.
Hiroshi
H
Yoneda
Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan.
Michiyasu
M
Suzuki
D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D020366:Methylmethacrylate; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000601:surgery
D020366:Methylmethacrylate; D011138:Polytetrafluoroethylene
Huygens principle; SAH; TCCS; acoustic impedance; titanium mesh plate; vasospasm