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How Do Volume Flow Measurements Complement Imaging in Cerebrovascular Surgery?

By Tim Callahan07 Dec 2022

Cerebrovascular surgeries require the utmost precision. Having data on the true volume of blood flow is powerful.

Intraoperative flow measurements eliminate guesswork, provide a quantitative assessment of flow and complement cerebrovascular surgeries in a number of different ways.

Arteriovenous malformations

When removing arteriovenous malformations (AVMs), intraoperative volume flow measurements help identify major draining veins, afferent vessels, and the AVM nidus on the surface.

Revascularization procedures

During revascularization procedures, intraoperative flow measurements can provide vital information on vessel patency of bypass.

Aneurysm clipping

Intraoperative volume flow measurements during aneurysm clipping help the surgeon find any modification of distal branch perfusion, as well as any residual aneurysm locations. Intraoperative flow measurements also help the surgeon avoid injury to any perforating arteries, a major cause of morbidity post-aneurysm clipping.

IC-EC bypass surgery

During IC-EC bypass surgery, volume flow measurements allow the surgeon to choose the most appropriate bypass and confirm their prediction of its patency.

Intraoperative flow measurements can assist the surgeon’s clinical assessment or let them know if an immediate correction of flow deficits is needed before completing the procedure.

How volume flow measurements complement imaging in cerebrovascular surgery: A case report

A Netherlands-based team led by RHGJ Van Lanen, studied the outcomes of aneurysm clipping procedures using intraoperative volume flow measurements and found that transit time flowmetry was a valuable tool “...providing quantitative measurements of arterial blood flow to help achieve optimal clip placement and minimizing aneurysm residuals that may be sites of rebleeding.”

Van Lanen, et al, looked at the outcomes of 190 patients with 213 aneurysms.

The team found that adequate flow was defined as ≥50% of baseline, which greatly reduced the risk of unfavorable outcome. Transit time flowmetry is a powerful tool in your arsenal during crucial moments.

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