Highlights
- •The Superb Microvascular Imaging (SMI) is applied for intracerebral hemorrhage (ICH) surgery.
- •Hematomas containing no vessels and no flow are clearly visualized in cerebrum.
- •Ultrasonograpy (US) with SMI, contrast agent and fusion techniques was used.
- •This US monitoring is useful for ICH surgery as a next-generation neuronavigator.
Abstract
Ultrasonography (US) has been used as a reliable imaging modality, providing real-time
information during neurosurgical operations. One recent innovative US technique, superb
microvascular imaging (SMI), visualizes small vessels and flow, which are not detected
with standard US with doppler. We apply SMI to intraoperative US monitoring in emergency
surgery for intracerebral hemorrhage (ICH).
Eleven consecutive patients with ICH underwent endoscopic emergency surgery under
US monitoring with SMI. After performing a small craniotomy, US images were obtained
using SMI, a fusion technique, and a contrast agent technique, with the probe on the
brain surface during surgery. Fusion images were obtained with the probe on the head
before craniotomy in some patients.
Animated US images with SMI could differentiate hematoma containing no vessels from
brain tissue, and flow images using SMI and contrast agent techniques clarified the
borderlines. Animated fusion images of intraoperative US and preoperative CT provided
information on the extent of hematoma and residual hematoma during emergency surgery.
We made various fusion CT images showing intracranial hematoma with US probes and
decided on the skin incision line before beginning surgery, as if we were using a
neuronavigation system.
US with SMI, contrast agent, and fusion techniques provide information on the extent
of intracranial hematoma and residual hematoma with no vessels and no flow. Monitoring
by US and fusion CT images is useful for ICH surgery as a next-generation neuronavigator.
Keywords
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Article info
Publication history
Published online: March 20, 2020
Accepted:
March 2,
2020
Received:
July 14,
2019
Identification
Copyright
© 2020 Published by Elsevier Ltd.
