Non-invasive assessment of extracranial--intracranial bypass grafts using advanced ultrasound technology. (Short Report).

There have been significant developments in ultrasound technology in the last few years which have resulted in an increase in the clinical value of this technique. An illustrative case is presented of how ultrasound technology has been used in the intraoperative and postoperative period to evaluate graft patency and function in patients undergoing extracranial--intracranial bypass graft surgery.

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Extracranial--intracranial (EC-IC) bypass grafting is an effective surgical treatment for the management of selected cases of intracranial aneurysmal disease that would not be amenable to surgical clipping or endovascular occlusion. (1-4) Catheter angiography is traditionally used for the perioperative assessment of graft function and patency. This type of imaging has various disadvantages. Catheter angiography is invasive and carries a finite morbidity, a consideration that is particularly important in patients who have undergone a neurovascular surgical procedure which is itself associated with morbidity. This factor becomes increasingly significant if repeated radiological assessment of graft function is necessary. Furthermore, the use of intraoperative angiography is limited by the difficulty in achieving adequate radiographic projection and angiographic quality in the operating theatre.

We describe the use of intraoperative and postoperative ultrasound for the assessment of graft patency and function. This imaging strategy provides an alternative approach to catheter angiography for the radiological assessment of EC-IC bypass.

CASE REPORT

A 50 year old woman presented with a four month history of right sided worsening ophthalmoparesis. There …