Neurosurgical Applications of Transcranial Doppler Sonography
In 1981, the Norwegian physiologist and cyberneticist, Rune Aaslid, developed a device which made it possible to apply the transcranial Doppler sonographic technique in man. In 1983, Dr. Albrecht Harders took on the project of working out a clinically pra
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Neurosurgical Applications of Transcranial Doppler Sonography
Springer-Verl~g
Wien New York
Dr. med. habil. Albrecht Harders Neurochirurgische UniversWitsklinik Freiburg i. Br., Federal Republic of Germany
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. © 1986 by Springer-Verlag/Wien Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.
With 109 Figures
Library of Congress Cataloging-in-Publication Data. Harders, A. (Albrecht), 1947. Neurosurgical applications of transcranial Doppler sonography. Bibliography: p. Includes index. 1. Brain-Blood-vessels-Surgery. 2. Transcranial Doppler ultrasonography. I. Title. [DNLM: 1. Blood Flow Velocity. 2. Cerebrovascular Circulation. 3. Cerehrovascular Disorders-physiopathology. 4. Ultrasonic Diagnosis-methods. WL 355 H259n.] RD594.2.H37. 1986. 617'.481. 86-22007
ISBN-13: 978-3-211-81938-8 e-ISBN-13: 978-3-7091-8868-2 001: 1O.l007/978-3-7091-8868-2
Foreword In 1981, the Norwegian physiologist and cyberneticist, Rune Aaslid, developed a device which made it possible to apply the transcranial Doppler sonographic technique in man. In 1983, Dr. Albrecht Harders took on the project of working out a clinically practicable method that would allow atraumatic measurements to be made of the blood flow velocity in the large branches ofthe circle of Willis. The technique has now become a competitor of the conventional methods of measuring the intracranial hemodynamics, including angiography and the xenon method of cerebral blood flow measurement. Harders proceeded from the assumption that the measurement of the blood flow velocity is more relevant for clinical diagnoses than the usual volume flow measurements. He stresses the very valuable application of the technique in detecting cerebral vasospasm before and after aneurysm surgery. The changes in the blood flow velocities measured by transcranial Doppler sonography in the individual vessel segments of the circle of Willis are interpreted with respect to the various factors that can effect such changes (collateral circulation in the circle of Willis, diameter of the vessel, vascular resistance, the general cardiovascular situation, arterial partial CO2 pressure, autoregulatory factors, position of body). The rate of complications associated with angiography has thus been reduced, since the best time both for angiography and for surgery can be determined, and continuous TCD examinations show when the patient is out of a critical phase of cerebral vasospasm. The use of the TCD examination technique in Freiburg has significantly improved the postoperative course. Ischemic deficits are becoming more and mo
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