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Avoidance of Major Vascular Injury in Transcranial Brain Tumor Surgery Using Real-Time Doppler Navigation: Technical
R Justin Garling1,2, Regin Jay Mallari1, Davendran Kanesen3
1Pacific Neuroscience Institute, Santa Monica , California , USA.
Operative Neurosurgery (Hagerstown, Md.)
|March 17, 2025
Summary
Routine Doppler probe use during brain tumor removal may prevent major arterial injury. While smaller vessel injuries can still occur, the Doppler probe aids dissection and guides aggressive removal, enhancing patient safety.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neuro-oncology
Background:
- The Doppler probe is valuable for intraoperative localization of critical neurovascular structures.
- Its utility in transcranial brain tumor surgery for preventing vascular injury remains under investigation.
Purpose of the Study:
- To evaluate the technique, outcomes, and neurovascular benefits of using a Doppler probe during craniotomy for brain tumor removal.
- To assess the incidence of vascular injury and stroke in patients undergoing brain tumor resection with Doppler probe assistance.
Main Methods:
- Retrospective analysis of 501 craniotomies (out of 840 total) for brain tumor resection where the Doppler probe was utilized between 2015 and 2022.
- Data collected included patient demographics, tumor pathology, extent of resection, and incidence of major/minor vascular injury, stroke, and infarction.
Main Results:
- A low rate of major vascular injury (<1%) was observed in craniotomies where the Doppler probe was used.
- Seven strokes (1.4%) resulted in permanent neurological deficits, and 26 asymptomatic infarctions (5.2%) occurred, primarily related to vasospasm or small vessel injury.
- One major injury was attributed to non-Doppler probe use, highlighting its protective role.
Conclusions:
- Routine Doppler probe use in transcranial brain tumor removal is associated with a low incidence of direct large vessel injury.
- The Doppler probe is particularly useful for guiding tumor dissection in cases with brain shift, where stereotactic navigation is less reliable.
- While not eliminating all vascular complications, Doppler probe use enhances safety by helping to avoid inadvertent major arterial injury during complex tumor resections.
