Data Sheet 1_Complex skull base brain tumor resection: the role of microvascular doppler in surgical precision and outcomes.docx

ObjectiveTo investigate the role of Doppler microvascular ultrasound (MVD) in skull base surgery for the intraoperative assessment and protection of arterial blood flow.
MethodsThe clinical data of 56 patients who underwent surgery at the Department of Neurosurgery, First Affiliated Hospital of Soochow University between September 2017 and June 2024 were retrospectively analyzed. All patients underwent skull base tumor resection assisted by intraoperative microvascular Doppler (MVD). The procedures involved complex skull base tumors, including lesions in the sellar region, sphenoid ridge, and cavernous sinus. During surgery, MVD was utilized to monitor blood flow in vessels adjacent to the tumors. The spatial relationship and patency of the vessels and tumors were evaluated in conjunction with preoperative multimodal imaging.
ResultsNo intraoperative vascular injuries were observed among the 56 patients, confirmed by intraoperative Doppler monitoring and postoperative imaging. All patients had favorable postoperative outcomes, including no new neurological deficits. MVD facilitated precise intraoperative localization and evaluation of blood vessels, which was quantitatively supported by significant increases in contrast-to-noise ratio (CNR) after Doppler application. In two representative cases, the addition of FLOW800 fluorescence imaging provided further CNR improvement, suggesting enhanced visualization and vascular protection. Details of the CNR quantification process are provided in the Methods section.
ConclusionMVD provides real-time intraoperative information on arterial blood flow during skull base surgeries, enabling surgeons to identify and preserve critical vessels, thereby improving surgical safety, resection accuracy, and patient outcomes. With ongoing technological advancements, the integration of MVD and fluorescence imaging is expected to play an increasingly vital role in complex skull base procedures.

目的 探讨多普勒微血管超声（Doppler microvascular ultrasound, MVD）在颅底手术中用于术中评估与动脉血流保护的作用。
方法 回顾性分析2017年9月至2024年6月于苏州大学附属第一医院神经外科接受手术的56例患者的临床资料。所有患者均接受术中微血管多普勒（MVD）辅助的颅底肿瘤切除术，手术涉及鞍区、蝶骨嵴、海绵窦等部位的复杂颅底肿瘤病变。术中通过MVD监测肿瘤毗邻血管的血流情况，并结合术前多模态影像学评估血管与肿瘤的空间位置关系及血管通畅性。
结果 56例患者术中均未发生血管损伤，经术中多普勒监测与术后影像学检查证实。所有患者术后恢复良好，未出现新发神经功能缺损。MVD可实现术中精准的血管定位与血流评估，多普勒应用后对比度噪声比（contrast-to-noise ratio, CNR）显著升高，为其提供了量化支持。在2例典型病例中，联合FLOW800荧光成像可进一步提升对比度噪声比，提示可视化效果与血管保护能力得到增强。对比度噪声比的量化流程细节详见方法部分。
结论 多普勒微血管超声（MVD）可在颅底手术中提供动脉血流的实时术中信息，帮助术者识别并保留关键血管，从而提升手术安全性、切除精准度与患者预后。随着技术的不断进步，MVD与荧光成像的联合应用有望在复杂颅底手术中发挥愈发重要的作用。