caa a22 4500 606213813 CHVBK 20210128101049.0 cr unu---uuuuu 210128e20150601xx s 000 0 eng 10.1007/s00701-015-2412-x doi (NATIONALLICENCE)springer-10.1007/s00701-015-2412-x Intraoperative cerebral angiosonography with ultrasound contrast agents: how I do it [Elektronische Daten] [Francesco Prada, Massimiliano Del Bene, Marco Saini, Paolo Ferroli, Francesco DiMeco] Background: Intraoperative vessel visualization is highly desirable, especially when the target is related to or close to main vessels, such as in the skull base and vascular surgery. Contrast-enhanced ultrasound (CEUS) is an imaging technique that allows visualization of tissue perfusion and vascularization through the infusion of purely intravascular ultrasound contrast agents (UCA). Methods: After cerebral scanning with B-mode ultrasound (US) CEUS is performed, UCA are injected and insonated with low mechanical index US. A UCA-specific harmonic signal is transduced using a contrast-specific algorithm to obtain real-time angiosonography (ASG). Conclusions: Real-time intraoperative ASG is a rapid, reliable, repeatable method for vessel visualization and evaluation of tissue perfusion. Key points: • ASG permits to assess vessel position, dimension, and relationships; it also allows a qualitative evaluation of flow entity and direction. • ASG shows vessels in depth without the need of their direct exposure, as for fluorescence-guided surgery. • ASG permits to study the entire vascular tree without the necessity to set gain or pulse repetition frequency as in Doppler imaging. • Vessels of interest can be visualized following their entire length across the surgical field, along the arterial, capillary, and venous districts. • ASG scan is repeatable multiple times throughout the operation, and each exam could be recorded as a clip to be visualized at a later stage. • In case of neoplastic lesion, ASG characterizes the perfusion pattern in three phases: arterial, venous, and parenchymal, permitting to visualize afferent and efferent vessels, facilitating the surgical strategy. • During tumor debulking, ASG shows the remaining distance to major vessels, providing information to avoid direct vessel damage. • In tumor and AVM surgery, ASG shows nidus or tumoral remnants that might be covered by healthy tissue, thus not visible on the surface. • In case of aneurysm surgery, post-clipping angiosonographic control confirms proper aneurysm exclusion and distal vessels flow. Springer-Verlag Wien, 2015 Intraoperative imaging nationallicence Ultrasound nationallicence Contrast-enhanced ultrasound nationallicence Angiography nationallicence Angiosonography nationallicence Vascular surgery nationallicence Skull base nationallicence Prada Francesco Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut Del Bene Massimiliano Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut Saini Marco Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut Ferroli Paolo Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut DiMeco Francesco Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut Acta Neurochirurgica Springer Vienna 157/6(2015-06-01), 1025-1029 0001-6268 157:6<1025 2015 157 701 https://doi.org/10.1007/s00701-015-2412-x text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2412-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Prada Francesco Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut NATIONALLICENCE 700 1- Del Bene Massimiliano Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut NATIONALLICENCE 700 1- Saini Marco Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut NATIONALLICENCE 700 1- Ferroli Paolo Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut NATIONALLICENCE 700 1- DiMeco Francesco Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, via Celoria 11, 20133, Milan, Italy aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/6(2015-06-01), 1025-1029 0001-6268 157:6<1025 2015 157 701