Cranial Ultrasound Dynamically Detection As Guidance In The Diagnosis And Treatment Of Premature Encephalopathy By Observing Hypoxia Cerebral Blood Flow Changes And In The Cerebral Tumor Resection Of Adults

Objective: Hypoxic-ischemic encephalopathy(HIE) is caused by hypoxia in perinatal period, and is a mainly reason of leading premature infants to dead and badly long-term complications of sequelae in nervous system. That will cause damage to not only family, but also the whole society. Cranial ultrasound as a simple and convenient method is widely used in diagnosis; it can detect abnormal structure modifications and hypoxia cerebral blood flow changes in the brain to assess severity of the damage. Combining the peak systolic velocity(PSV), end diastolic velocity(EDV), resistance index(RI) of middle cerebral artery(MCA) with B-mode ultrasonogram, and then by means of comparing the results from more than once detections in the period of treatment. That can supply objective gist to the diagnosis and treatment of premature encephalopathy, and the parameters that reflect haemodynamics more intuitively than B-mode ultrasonogram.For the past few years, the morbidity of adult cerebral tumor increased to a certain extent. The particularly of these kind of tumor determines the way of resection transform to minimally invasive surgery. Ultrasound was used to locate the position of the tumor accurately in order to minimize the iatrogenic damage during the surgical operation and enhance the quality of life after surgical operation.The purpose of this study is to investigate the value of cranial ultrasound dynamically detection as a guidance in the diagnosis and treatment of premature encephalopathy by observing hypoxia cerebral blood flow changes and in the cerebral tumor resection of adults.Methods:1 The study was conducted at the Newborn Intensive Care Unit(NICU) of Department of Pediatrics in the Fourth Affiliated Hospital of Hebei Medical University in China from February 2013 to December 2014. 60 cases premature infants were chosen, the birth weight is 1862 ± 499 g, gestational age is 33+3±2 weeks.Within 3 days at postnatal were given cranial ultrasound routinely, in order to detect abnormality both in structure and in blood flow changes of brain. Measure the PSV, EDV and RI of the two sides of MCA via Color Doppler Flow. After the birth 7 days, all the cases were given cranial ultrasound once again, especially pay close attention to the abnormal parameters in the first examination, then detect the PSV, EDV and RI to analysis the diagrams.2 The study was conducted at the Department of Neurosurgery in the Fourth Affiliated Hospital of Hebei Medical University in China from August 2013 to May 2014. 16 patients(8 males,and 8 females)who were operated cerebral tumor took magnetic resonance imaging(MRI) before the surgery, in order to confirm the tumor’s general location and orientation and acquire an understanding of the shape of the tumor. After taking down bone flap of relevant position, patients were underwent intraoperative ultrasound to gain a more accurate the position, shape and the scope of surgery. In order to identify whether the part of the tumor were left, at the end of the procedure, we performed intraoperative ultrasound once again. Combined patients’ recovery in progress to analysis quality of the surgery.Results:1 In the first examinations of the 60 cases, 17 cases were abnormal in PSV(28%), among them 7 cases both sides were abnormal. 24 cases were abnormal in EDV(40%), among them 9 cases both sides were abnormal. 19 cases were abnormal in RI(32%), among them 10 cases both sides were abnormal. In the reexamination, 12 of the 17 PSV abnormal cases recovered to normal level, 14 of the 24 EDV abnormal cases recovered to normal level, 15 of the 19 RI abnormal cases recovered to normal level. Among the cases that changes weren’t obvious, 1 cases one side RI below 0.60 in the first exam, although the side RI reduced to normal level in the reexamination, the other side RI rise up to 0.80.In the first examination, all the cases without abnormal parameters, in the 7th day when reexamed these cases, the parameters changed inconspicuously, PSV changed less than 0.15m/s, EDV changed less than 0.07m/s, RI changed less than 0.09.2 Because of the change of intracranial pressure and the disappearance of the cerebrospinal fluid, the position and orientation of the tumor from ultrasound didn’t completely agree with the image of per-operative based on the combination of the two methods. Brain tissue deformed after taking down bone flap in 3 cases, even so, intraoperative ultrasound still displayed the whole tumor through the window of the bone. Then based on the images of ultrasound to identify and guide the location, in order to seek the best path for surgeon in the procedure. That can avoid damaging the important area. 15 cases, tumors were completely removed by once. Another case was underwent intraoperative ultrasound again and again in the process, because the tumor’s position was so deep that the process of seeking were effected by the sulus.Conclusions:1 Parametres of MCA in the first 3 days of neonatal perform a significant role to the diagnosis and treatment in period of premature encephalopathy. Recent years, bedside ultrasound machines that are used in clinic increasingly make the method simple and convenient, and the method with no pain, no damage, low cost. Moreover, it can be available dynamically and continuously. Because of updating of the machines constantly, we can obtain more distinct images to understanding the encephalic condition more comprehensively and meticulously. Through temporal window, the Circle of Willis can clearly present, then we can measure the parameter of each point directly. Based on these parameters’ changes to infer the severity of encephalic lesion and assess impact to prognosis. This mean is used to detect encephalic condition dynamically and discover deterioration of brain in time. It plays a significant role in taking emergency treatment without delay. By comparing the results of repeating exam to provide guidance and assessment to further clinic treatment and prognosis to a certain extent.2 Intraoperative ultrasonography can clearly display the location of cerebral tumors in a real-time, no-wound and convenient way, combining with per-operative MRI can assistant surgeons to identify the location, shape and boundary of the tumor, and to directly monitor the resection condition, and therefore it can further raise the security and the therapeutic effect.