By R. E. Anderson, J. E. Boggan, L. J. Cerullo, M. C. Chan, G. J. Dohrmann, M. S. B. Edwards, V. A. Fasano, J. M. Gilsbach, A. Harders, R. M. Ikeda, P. J. Kelly, E. R. Laws Jr., G. Lee, T. Letardi, D. T. Mason, C. R. Neblett, R. W. Rand, A. Renieri, I. L. Ri
Since the advent of electrosurgery the recommendations of surgical procedure at the fearful approach have gone through extra advancements (bipolar coagulation, microscope), no matter if the process used to be no longer considerably converted. this day, laser represents a brand new "discipline", because it bargains a brand new method of appearing all easy maneuvers (dissection, demolition, hemostasis, vessel sutures). additionally, laser bargains the potential of a different maneuver, particularly aid of the amount of a tumoral mass via vaporization. Its program isn't really limited to standard neurosurgery yet extends additionally to stereotactic and vascular neurosurgery. Laser surgical procedure has additionally stimulated the anesthesiologic recommendations. while new instrumentation has been brought: CUSA ultrasonic aspiration, echotomography, and Doppler flowmeter. i've got had the opportunity to make use of those new applied sciences all at a time and feature come to the realization that we face the sunrise of a brand new method which has already proven its validity and shortage of inconveniences, and whose item is to extend the precision of neurological surgical procedure. The technological improvement remains to be occurring, and a few advancements are to be foreseen. Laser scalpel is splitting the preliminary laser surgical procedure into NO contact and contact surgical procedure with laser. As new instrumentarium should be built, a variable and tunable beam becomes on hand. for instance, in many years loose Electron Laser will additional upload to the development during this field.
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Hemodynamically effective stenoses due to a tight clip were indicated by a markedly reduced flow velocity in comparison with the preexisting findings (Fig. 11). The detection of a localized acceleration, which is important for recognizing a minor stenosis was restricted mostly by the size of the probe, the spring of the clip, and the narrow conditions at the base of the brain. The response of the cerebral vessels to mechanical and chemical stimuli during the operation often brought on changes in the flow pattern.
37, 626-629. 23. Hartley, C. , 1981: Resolution of frequency aliases in ultrasonic pulsed Doppler velocitimeters. IEEE Trans. So nics Ultrastruct. 28, 69-74. 24. Hitchon, P. , Kassell, N. , McDonnell, D. , 1979: The Doppler ultrasonic flowmeter as an adjunct to operative management of cerebral arteriovenous malformations. Surg. Neurol. 11, 345-347. 25. Jorgensen, J. , Campau, D. , Baker, D. , 1973: Physical characteristics and mathematical modelling of the pulsed ultrasonic flowmeter. Med. BioI.
According to animal experiments (Gilsbach 1983, Freed et al. 1979) stenoses of more than 40% could be detected with the Doppler, and any necessary corrections could be made immediately and under Doppler control. Extracranial-Intracranial Bypass Procedures The precise and narrow beam of the microvascular Doppler system was a useful preoperative aid in mapping the course of the donor artery on the skin. The patency of the donor artery after an anastomosis could easily be proved by a conventional Doppler or an electromagnetic flow meter.