By Dr. med. habil. Albrecht G. Harders (auth.)
In 1981, the Norwegian physiologist and cyberneticist, Rune Aaslid, constructed a tool which made it attainable to use the transcranial Doppler sonographic method in guy. In 1983, Dr. Albrecht Harders took at the venture of understanding a clinically doable process that might permit atraumatic measurements to be made up of the blood circulation speed within the huge branches ofthe circle of Willis. The approach has now develop into a competitor of the normal tools of measuring the intracranial hemodynamics, together with angiography and the xenon approach to cerebral blood movement dimension. Harders proceeded from the belief that the size of the blood movement speed is extra correct for scientific diagnoses than the standard quantity move measurements. He stresses the very beneficial program of the procedure in detecting cerebral vasospasm ahead of and after aneurysm surgical procedure. The alterations within the blood movement velocities measured via transcranial Doppler sonography within the person vessel segments of the circle of Willis are interpreted with recognize to some of the components which could influence such adjustments (collateral movement within the circle of Willis, diameter of the vessel, vascular resistance, the final cardiovascular state of affairs, arterial partial CO strain, autoregulatory elements, place of body). the speed of two issues linked to angiography has hence been diminished, because the most sensible time either for angiography and for surgical procedure might be made up our minds, and non-stop TCD examinations express while the sufferer is out of a severe section of cerebral vasospasm.
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Additional info for Neurosurgical Applications of Transcranial Doppler Sonography
Although the frequencies increased up to day 10, the clinical status improved continuously up to day 9. The frequencies were higher on the side on which the Sylvian fissure was split. Frequencies decreased slowly up to day 15, then increased from day 15 to day 19 after intravenous administration of nimodipine had been discontinued Vasospasm Between Day 4 and Day 31 After SAH Individual Cases With regard to the time course of the frequency changes in the middle cerebral arteries, the typical velocity changes can be demonstrated by the following single example (Fig.
I .. • .... .. 50 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 IS 19 20 21 22 23 24 2S 28 days after SAH ~ 29 29 30 2 3 4 5 6 months Fig. 32. The time course of frequency changes in the two MCAs after early aneurysm operation shows a higher velocity on the side of the operative approach. l:: EARLY OP(n=47) side of transsylvian approach MCA - - Hunt/Hess II -------. 50 [ J QJ l 4- 1. :l 2B 29 days after SAH ao '2 3 4 5 6 months Fig. 33. The preoperative clinical grading according to Hunt and Hess gives no prediction of the postoperative frequency changes.
Finally, a "smoothing spline function" based on local cubic polynomials was calculated in such a way that the integral of the error squared was minimal (Fig. 19). CT grading of the SAH, which was modified according to Fischer , is represented in Table 3. Results The measurements of the frequency changes in the first four weeks after SAH shows that these changes are most pronounced in the MCA and in the supraclinoid portion of the lCA (Figs. 20 and 21). The least changes were found in the posterior cerebral artery.