Accurate characterization of the main trunk of the anterior cerebral artery by means of intraoperative sononavigation with Doppler sonography: implications for brain tumor surgery.

OBJECTIVE: Doppler sonography can be used for real-time intraoperative localization of arteries within or near brain tumors but is less useful for distinguishing between arteries with similar diameters, such as the main trunk and branches of the anterior cerebral artery (ACA). By contrast, sononavigation provides real-time information in alignment with magnetic resonance imaging scans and may be of use in characterizing the identity of individual arteries on Doppler sonographic images. The goal of this study was to determine whether sononavigation can distinguish the main trunk of the ACA from the branches of the ACA on Doppler sonographic images.

METHODS: Doppler sonography was used in 3 patients undergoing surgical resection of brain tumors involving the main trunk of the ACA. The location of the main trunk of the ACA was characterized by sononavigation.

RESULTS: With these data, tumor resection was performed with preservation of the main trunk of the ACA. Gross total resection was achieved in 1 case.

CONCLUSIONS: Intraoperative sononavigation with Doppler sonography accurately localized the main trunk of the ACA and enabled preservation of this structure during tumor resection. This method may be applicable to the characterization of other critical arteries and may allow tumor resection with decreased morbidity.