Recently, intraoperative ultrasonography has been becoming increasingly useful for evaluation and monitoring of surgical procedures during spinal cord decompression. We evaluated the degree of decompression and fluid circulation around the cord using ultrasonography during laminoplasty. Laminoplasty was performed by vertical division of the spinous process (Kurokawa method). Intraoperative ultrasonography was performed using an Aplio instrument(Toshiba Medical) with a 6.5 MHz transducer. Spinal decompression was evaluated by delineation of the spinal cord, the subarachnoid space or the shape of the osteophyte, and dynamic imaging of the cerebrospinal fluid and blood flow in the epidural venous plexus with the pulse Doppler method. Intraoperative ultrasonography was performed for 5 patients with cervical myelopathy. This revealed the ventral and dorsal subarachnoid space as well as pulsatile movement of the spinal cord in all 5 patients after satisfactory cord decompression. The flow velocity of the cerebrospinal fluid around the spinal cord measured 1.5-3.0cm/ in 2 patients, and that in the epidural venous plexus measured 5.0-10.0cm/s in 3 patients. This improved circulation was considered to have been due to the spinal cord decompression, and the preoperative symptoms were ameliorated in all patients. Intraoperative ultrasonography is considered useful for real-time evaluation of spinal cord decompression during laminoplasty for cervical myelopathy.
Objective: To assess the usefulness of transcranial color flow imaging(TCCFI) for vasospasm, we evaluated the flow velocities in the middle cerebral artery (MCA) and anterior cerebral artery (ACA) using TCCFI in patients with subarachnoid hemorrhage (SAH) due to aneurysmal rupture. Methods: Clinical results were obtained in 14 consecutive patients who suffered SAH due to aneurysmal rupture and underwent neurosurgical procedures between December 2004 and September 2005. Using TCCFI, the MCA and ACA were detected and their peak systolic flow velocities (Vs) were determined on days 3,7 and 14. Results: Almost all of the 14 patients had a good outcome (GR 11 cases, MD 2 cases, SD 1 case, dead 0 case). There was no significant increase of M1 and A1 Vs with time. Symptomatic vasospasm was observed in 3 patients, all of whom were elderly, deteriorated after day 8, and in whom a rise in M2 Vs preceded the symptoms. Conclusion: TCCFI appears to be useful for evaluation of vasospasm, especially in the M2 segment.
Deformation of plaque in the carotid artery was studied in 7 patients by B-mode ultrasonography. The plaque showed a change in shape due to pulsatile blood flow. Five of the patients had suffered cerebral stroke. There are many risk factors of embolism that can cause stroke, and soft plaque is an important risk factor for cerebral infarction. We coined the term “jellyfish sign” for this unstable deformation pattern of soft plaque. Unstable movement of the plaque suggests that it may contain a soft area and hemorrhage under a thin cap, which might easily cause rupture and artery to artery embolism. B-mode is useful for revealing such high-risk plaque showing the “jellyfish sign”.