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Directional Intraoperative Doppler Ultrasonography During Surgery on Cranial Dural Arteriovenous Fistulas

Eide, Per Kristian MD, PhD*,‡; Sorteberg, Angelika G. MD, PhD*; Meling, Torstein R. MD, PhD*; Sorteberg, Wilhelm MD, PhD*

doi: 10.1227/NEU.0000000000000061
Instrumentation and Technique

BACKGROUND: Directional intraoperative Doppler (dioDoppler) ultrasonography is well established as a tool in the surgery of intracranial aneurysms and cerebral arteriovenous malformations. The literature provides little information about the possible usefulness of this method during surgery on cranial dural arteriovenous fistulas (dAVFs).

OBJECTIVE: To present our experience with the use of dioDoppler during surgery on cranial dAVFs.

METHODS: All patients undergoing craniotomy for cranial dAVF from January 2007 to October 2012 in which dioDoppler was used were included in the study. We reviewed patient records, operating protocols, radiological images, dioDoppler files, and intraoperative videos.

RESULTS: During the study period, 12 patients with cranial dAVFs underwent surgical treatment facilitated by dioDoppler. Four patients were operated on acutely for cerebral bleeds, and 8 patients were treated for various cerebral symptoms and the assumption of a significant risk for intracranial bleed. Three advantages of dioDoppler were unequivocal identification of veins with cortical/deep venous reflux from the fistula, verification of completeness of occlusion of the fistula, and identification of dural arterial feeders not visualized under the microscope.

CONCLUSION: Reviewing our experience, we found that dioDoppler sonography is an easy, safe, effective, reliable, and instantaneous tool during surgery on cranial dAVFs.

ABBREVIATIONS: dAVF, dural arteriovenous fistula

dioDoppler, directional intraoperative Doppler

DSA, digital subtraction angiography

*Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway;

Faculty of Medicine, University of Oslo, Oslo, Norway

Correspondence: Per Kristian Eide, MD, PhD, Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Pb 4950 Nydalen, N-0424 Oslo, Norway. E-mail:

Received November 28, 2012

Accepted June 19, 2013

Copyright © by the Congress of Neurological Surgeons