脳神経外科における術中超音波診断　―セクタ電子走査型超音波診断装置の応用―

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  • Intraoperative Application of Sector Scanning Electronic Ultrasound in Neurosurgery

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Since October 1979, real-time gray-scale ultrasonography has been intraoperatively performed on 18 patients who had previous preoperative CT examinations.<BR> Electronic linear scanning ultrasonography was applied in the first three cases using a probe pressed against the dura mater or the brain surface with an intervening saline-filled rubber bag. This, however, proved unsatisfactory because of poor contact between the probe and the brain and also because of a relatively narrow scanning field deep in the brain.<BR> Fifteen cases were examined using electronic sector scanning ultrasonography combined with probes of either 2.4 MHz. or 3.0 MHz. ultrasonic frequencies. After sterilization, the probe was gently pressed against the brain surface which was moistened with saline solution. The visible field deep in the brain with the sector type ultrasonography was wide due not only to the fan-shaped (78°) scanning field but also to the relatively easy manual angulation of the scanning probe. Ventricles, falx and the inner surface of the skull were always visualized, and these findings were helpful in orienting the operative field.<BR> In five cases with early operations against ruptured intracranial aneurysms, the lateral ventricles were well visualized. In one of these cases, a ventricular tap and subsequent insertion of a drainage tube were performed with confidence and ease although the anterior horns were fairly narrow. In one case of spontaneous intracerebral hemorrhage, use of ultrasound was most helpful in selecting the corticotomy site. The extent of the hematoma cavity was disclosed by placement of a G18 ventricular needle as a marker. The introduction of the probe intracerebrally through the corticotomy gap showed no residual clot.<BR> Among five supratentorial tumors, three subcortical tumors were visualized, but one small pituitary adenoma and one small skull base tumor were not. One subcortical solid tumor (glioblastoma multiforme) was remarkably echogenic and this was successfully needle-biopsied under ultrasonic monitoring. This should be the first step in the future development of ultrasonically-guided stereotactic biopsy. Two subcortical cystic tumors were easily punctured and aspirated under ultrasonic monitoring. However, the full extent of the needle was not well visualized even though the surface of the needle had been roughened to enhance the echogenicity. Good alignment of the needle with the fan-shaped ultrasound field using, for instance, a mechanical needle holder might give better visualization.<BR> In one case of chronic subdural hematoma and three cases of infratentorial tumors, the pathologies were visualized although they were not particularly contributary to the operation.<BR> Therefore, electronic sector scanning ultrasonography was useful, when combined with preoperative CT examinations, in operations on the supratentorial subcortical mass and in intraoperative punctures of the ventricles and/or cysts.

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