Ultrasound Guided Microsurgery Of Deep Cerebral Cavernous Hemangioma

Purpuse: To explore the application of real-time ultrasonography in intracranial cavernous hemangioma's intraoperative positioning and the clinical value of intraoperative ultrasond in helping formulate the best surgical approach for patients, detecting the scope and extent of resection, shortening the operating time and reducing the postoperative complications,We compare the treatment effects between the treatment method of lesions removed under the traditional position pattern and the treatment method of lesions removed under real-time ultrasonography positioning during operation.Material and method: (1). Retrospective analysis of clinical data of 54 cases from Mar. 2005 to Mar. 2010,who be preoperative diagnosised with cerebral cavernous hemangioma by MRI in our department. Those patients all experience surgical treatment and be verified by pathology as Cavernous hemangioma after operation. (2). 28 out of 54 patients were performed microsurgical resection under the orientation of intraoperative ultrasond, which can completely display the position, size, morphology, deep, properties, inner structure and the relationship with surrounding tissue and vessels. It also can provide the best surgical approach for operator, perform real-time scanning in the surgical course, monitor the lesion resection and probe again to observe whether resident lesion and hematoma are present after the end of surgery. The other 26 patients follow the traditional method to position by CT or MRI before operation, and rescect under microscope. (3). To observe the operation effect within 2 weeks after surgery, compare the differences under the two operational ways such as the time of removing lesion,the improvement of symptoms after operation and complications and so on.Review the MRI of head after 4-6 months to know the extent of lesion- resecting,evaluate the postoperative effect of cavernous hemangioma resection by ultrasound navigation.Result:(1). There are no therapeutic deaths in all patients. All cases were total resected under microscope and recovered to good condition after treatment. 54 Patients be preoperative diagnosised with cerebral cavernous hemangioma by head MRI and all be verified by pathology after opertion. The conformity degree between MRI and pathology is 100%.(2). All 54 lesions all can be find under the microscopie. 28 patients with the use of intraoperative ultrasound positioning, whose lesions all be display. The display rate is 100%.The size, position, scope and morphology of cavernous hemangioma can be completely display under intraoperative ultrasond. All lesions can be positioned accurately, especially can provide the best surgical approach to the small and deep lesion. Probe again before the end of operation. The resident lesion and hematoma be dispalyed by ultrasound images all be confirmed in surgery. (3). Intraoperative ultrasound can successfully guide the operator resect the intracranial lesions. The average time of surgical resection in ultrasound group is 41.90min, The average time of surgical resection in traditional group is 65.88min, by statistical analysis between the two, P<0.05, the differences have statistically significance. (4). Observe the complications of the symptoms improved, bleeding or not, epilepsy(or the original epilepsy aggravate), nerve dysfunction within 2 weeks after operation. The complications of the ultrasound group are 3 cases, account for 10.7%. The complications of the traditional group are 9 cases, account for 34.6%.Complication rate of the ultrasound group was significantly lower than complication rate of the traditional group.Conclusion:(1). Head MRI is sensitive to intracranial cavernous hemangioma, which can be diagnosed on MRI. (2). Intraoperative real-time ultrasonography is accurate and reliable to deep cerebral cavernous hemangioma lesions positioning, which can guide operator approach accurately, avioding the important function area, vessels and nerves and shorten the operating time effectively. Compared to the traditional operation mode, review and follow-up after operation discover that microsurgical resection of cerebral cavernous hemangioma guided by intraoperative ultrasound can obvious reduce the incidence of complications.