電子式セクタ走査型装置による術中超音波診断 : 開頭・穿頭・椎弓切除における実用性

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Digitally controlled ultrasonography using a 5-MHz mini-sized, sector-scanning probe was per-formed in 21 cases of craniotomy, in 22 cases of burr-hole opening, and in 2 cases of laminectomy. The probe could be sterilized. The tip of the probe measured 17.8X 19.6 mm. Among craniotomy cases, one small pituitary adenoma case and two small berry aneurysm cases failed visualization. Another adenoma and a large aneurysm were imaged. Ultrasound was helpful in 11 cases (52%), and most of them were supratentorial intraparenchymal masses, such as gliomas and intracerebral clots. In 5 of them puncture and/or biopsy was successfully performed under ultrasonic monitoring: 2 manually and 3 using a needle-guide apparatus and a guideline superimposed on the cathode-ray tube image. Maneuverability of the biopsy needle or forceps could be controlled, and no hemor-rhage was encountered. The burr-holes were mostly conically enlarged using a Hudson No. 3 drill. Sterile echo-jelly was placed in the gap between the probe tip and the dural surface. Two targets were not visualized; one was an aneurysm and the other a cavernous sinus tumor. In 2 ventricular tappings through the hole, ultrasound showed both the direction and the depth of the target. In a case of brain abscess, two burr-holes were placed so that an ultrasonically monitored puncture could be performed using the needle-guide apparatus. The needle tip position could be adjusted according-ly with the gradual shrinkage of the capsule by aspiration. In 2 cases of laminectomy, the normal subarachnoid space was clearly exhibited. In a total of five cases, ultrasound was found not only helpful but in fact indispensable. However, several imperfections were noted: First, areas close to the probe could hardly be seen due to the near-field artifact. Second, the thickness of the ultrasonic beam limited image resolution in its direction. Third, the size of the probe was still larger than the diameter of a burr-hole. Finally, there were still image artifacts due to the sidelobe, reverberation, and acoustic enhancement, especially when metallic material was introduced into the ultrasonic field. In conclusion, electronic sector-scanning ultrasonography should become an indispensable tool in the neurosurgical operating theater in the near future.
日本脳神経外科学会の論文
1984-08-15

電子式セクタ走査型装置による術中超音波診断 : 開頭・穿頭・椎弓切除における実用性

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