INTRAOPERATIVE ANGIOGRAPHY IN THE MANAGEMENT OF NEUROVASCULAR DISORDERS *

Abstract BACKGROUND: Reports of cervical perimedullary arteriovenous shunt (PMAVS) are limited, and treatment strategies have not been established. OBJECTIVE: To describe angioarchitecture and optimal treatment strategies for cervical PMAVS. METHODS: We treated 22 patients with cervical PMAVS between 2000 and 2012 (8 women and 14 men; age, 9-80 years). According to the classification, our patients included type IVa (4 patients), type IVb (16 patients), and type IVc (2 patients). Seventeen patients presented with subarachnoid hemorrhage. RESULTS: A total of 41 shunting points were localized in 22 patients, of which 34 points were located ventral or ventrolateral to the spinal cord. The anterior spinal artery (ASA) contributed to the shunts in 16 patients. Aneurysm formation was identified in 8 patients. Endovascular treatment was attempted in 3 patients, resulting in complete obliteration in 1 patient (type IVc). Overall, 21 patients underwent open surgery. An anterior approach with corpectomy was elected for 2 patients; the other 19 patients underwent the posterior approaches using indocyanine green videoangiography, intraoperative angiography, endoscopy (8 patients), and neuromonitoring. Twenty patients were rated as having a good recovery at 6 months after surgery. No recurrence was observed in any patients during the follow-up (mean, 59.7 months). CONCLUSION: Shunting points of the cervical PMAVS were predominantly located ventral or ventrolateral to the spinal cord and were often fed by the ASA. Even for ventral lesions, posterior exposure assisted with neuromonitoring and endoscopy, and intraoperative angiography provided a view sufficient to understand the relationships between the shunts and the ASA and contributed to good surgical outcomes.

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Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽

10.1227/neu.0000000000000228 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S32-S41 ◽

Cited By ~ 19

Author(s):

Patrick P. Youssef ◽

Albert Jess Schuette ◽

C. Michael Cawley ◽

Daniel L. Barrow

Keyword(s):

Treatment Options ◽

Venous Drainage ◽

Venous Hypertension ◽

Surgical Approaches ◽

Dural Sinus ◽

Intraoperative Angiography ◽

Indocyanine Green Videoangiography ◽

Arteriovenous Fistulas ◽

The Past ◽

Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

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Intraoperative Angiography Using Portable Fluoroscopy Unit in the Treatment of Vascular Malformation

Neurologia medico-chirurgica ◽

10.2176/nmc.oa.2014-0315 ◽

2015 ◽

Vol 55 (6) ◽

pp. 505-509 ◽

Cited By ~ 5

Author(s):

Kentaro HAYASHI ◽

Nobutaka HORIE ◽

Yoichi MOROFUJI ◽

Shuji FUKUDA ◽

Susumu YAMAGUCHI ◽

...

Keyword(s):

Vascular Malformation ◽

Intraoperative Angiography

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Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations

Journal of Neurosurgery ◽

10.3171/jns.1990.73.4.0526 ◽

1990 ◽

Vol 73 (4) ◽

pp. 526-533 ◽

Cited By ~ 125

Author(s):

Neil A. Martin ◽

John Bentson ◽

Fernando Viñuela ◽

Grant Hieshima ◽

Murray Reicher ◽

...

Keyword(s):

Digital Subtraction Angiography ◽

Intracranial Aneurysms ◽

Vascular Malformations ◽

Operating Table ◽

Digital Subtraction ◽

Intraoperative Angiography ◽

Content Type ◽

Head Holder ◽

Cerebral Embolization ◽

Leg Ischemia

✓ Intraoperative digital subtraction angiography using commercially available equipment was employed to confirm the precision of the surgical result in 105 procedures for intracranial aneurysms or arteriovenous malformations (AVM's). Transfemoral selective arterial catheterization was performed in most of these cases. A radiolucent operating table was used in all cases, and a radiolucent head-holder in most. In five of the 57 aneurysm procedures, clip repositioning was required after intraoperative angiography demonstrated an inadequate result. In five of the 48 AVM procedures, intraoperative angiography demonstrated residual AVM nidus which was then located and resected. In two cases intraoperative angiography failed to identify residual filling of an aneurysm which was seen later on postoperative angiography, and in one case the intraoperative study failed to demonstrate a tiny residual fragment of AVM which was seen on conventional postoperative angiography. Two complications resulted from intraoperative angiography: one patient developed aphasia from cerebral embolization and one patient developed leg ischemia from femoral artery thrombosis. This technique appears to be of particular value in the treatment of complex intracranial aneurysms and vascular malformations.

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Intraoperative Angiography Using Laser-Assisted Indocyanine Green Imaging to Map Perfusion of Forehead Flaps

Archives of Facial Plastic Surgery ◽

10.1001/archfaci.2011.1540 ◽

2012 ◽

Vol 14 (4) ◽

pp. 263-269

Author(s):

Charles R. Woodard ◽

Sam P. Most

Keyword(s):

Indocyanine Green ◽

Intraoperative Angiography

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Intraoperative angiography for visceral arteries originating from false lumen

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211041457 ◽

2021 ◽

pp. 021849232110414

Author(s):

Shintaro Takago ◽

Satoru Nishida ◽

Yukihiro Noda ◽

Yu Nosaka ◽

Ryo Yamamura ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Circulatory Arrest ◽

False Lumen ◽

External Iliac Artery ◽

Acute Type ◽

Elephant Trunk ◽

Intraoperative Angiography ◽

Visceral Arteries ◽

Enhanced Computed Tomography

A 70-year-old man had an acute type B aortic dissection 9 years before his admission. The last enhanced computed tomography that was performed revealed an aneurysm that extended from the ascending aorta to the aortic arch, associated with a chronic aortic dissection, which extended from the aortic arch to the left external iliac artery. His visceral arteries originated from the false lumen. We performed a total arch replacement with a frozen elephant trunk in the hybrid operating room. Immediately after the circulatory arrest termination, using intraoperative angiography, we verified that the blood supply to the visceral arteries was patent.

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Does the Use of Intraoperative Angiography Reduce the Incidence of Postoperative Wound and Flap Complications in Complex Lower Extremity Oncologic Reconstruction?

Annals of Plastic Surgery ◽

10.1097/sap.0000000000002800 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Kailash Kapadia ◽

Maragaret Dalena ◽

Zachary Cavanaugh ◽

Haripriya Ayyala ◽

Joesph Ippolito ◽

...

Keyword(s):

Lower Extremity ◽

Intraoperative Angiography ◽

Postoperative Wound

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Intraoperative angiography in the resection of arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/jns.1994.80.1.0073 ◽

1994 ◽

Vol 80 (1) ◽

pp. 73-78 ◽

Cited By ~ 29

Author(s):

Shigetaka Anegawa ◽

Takashi Hayashi ◽

Ryuichiro Torigoe ◽

Katsuhiko Harada ◽

Shun-ichi Kihara

Keyword(s):

Surgical Resection ◽

Arteriovenous Malformations ◽

Three Dimensional ◽

Initial Operation ◽

Total Resection ◽

Intraoperative Angiography ◽

Content Type ◽

Fine Print

✓ Surgical resection of 13 operatively obscure arteriovenous malformations (AVM's) was accomplished with the assistance of intraoperative angiography, which was performed stereographically to provide three-dimensional orientation and was repeated until total resection of the AVM was confirmed. All films obtained were subtracted to improve clarity. The method presented here may be useful for the resection of all types of AVM. Only two patients had residual AVM after the initial operation. No complications attributable to angiography were noted.

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