Oct. 21, 1998 LOS ANGELES (October 19, 1998) - A new type of technology known as intraoperative Duplex Scanning was used for the first time at Cedars-Sinai Medical Center last month, and played an important role in saving the life of carjacking victim Mark Watson*. "In fact," says Hrayr Shahinian, M.D., a skull base surgeon and director of Cedars-Sinai Medical Center's Skull Base Institute, "this patient probably would not have survived had he been 'carjacked' just a few years ago instead of this past September, or had he not been taken to a hospital with this type of cutting-edge imaging technology and highly skilled brain, cardiac and surgical intensive care teams."
Duplex scans combine two types of imaging technology - doppler and ultrasound - giving the physician both auditory and visual images of blood flow and enabling him or her to differentiate between blood vessels and other types of tissues. "When the probe is placed near an artery, you can hear a pulsing sound and the picture is bright red," says Dr. Shahinian.
"When the probe is near a vein, the sound is steady rather than pulsing, and the visual image is more of a yellow-red. If there is no signal, it indicates that the flow has been interrupted by the injury, and that's the area that will need ligation or repair."
In Watson's case, he had sustained critical gunshot wounds to his brain which had resulted in injury to the left sigmoid sinus. "The bullet in his head had entered behind his left ear and exited behind his right ear, and he was hemorrhaging badly," says Dr. Shahinian. Compounding the problem was the fact that a second bullet had entered Watson's chest. "Because of the massive bleeding from both locations, either of these wounds could have been fatal."
Because the heart injury involved high-pressure, pumping-type bleeding from an artery, surgeons decided to use temporary packing to stop the brain hemorrhaging (which was venous) while they repaired his heart. During the heart surgery, however, Watson's body temperature dropped to dangerous levels and his blood was no longer clotting.
"It was too risky to try repairing the head wound at that point, so he was taken to the Surgical Intensive Care Unit (SICU) until his critical condition could stabilize and we could safely operate on his head wound," says Dr. Shahinian. The Duplex scan indicated that the sigmoid sinus was damaged, and a CAT scan of the patient's head showed that he had alson suffered a stroke in the cerebellum.
Because the patient's condition was so critical, it was important to make any operation as minimally invasive as possible. Using the Duplex scanning technology, Dr. Shahinian was able to pinpoint the injury before opening the patient's head surgically three days later. Then during the surgery itself, the technology was used again, this time intraoperatively, to confirm the area of injury and to minimize the invasiveness of the surgery.
"Without the information provided by the Duplex study, we would have had to open the patient much more invasively, and given his other injuries and his critical condition, that would not have been safe," says Dr. Shahinian Watson is expected to fully recover.
*Name and details have been changed to protect the patient's privacy.
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