Intraoperative Spinal Digital Subtraction Angiography: Technique and Results

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 603-609 ◽  
Author(s):  
Ludwig Benes ◽  
Jörg-Peter Wakat ◽  
Ulrich Sure ◽  
Siegfried Bien ◽  
Helmut Bertalanffy
Keyword(s):  
Digital Subtraction Angiography ◽  
Wound Closure ◽  
Vascular Malformations ◽  
Vascular Anatomy ◽  
Vascular Lesions ◽  
Digital Subtraction ◽  
Segmental Artery ◽  
Spinal Vascular Malformations ◽  
Clinical Records ◽  
Methodological Aspects

Abstract OBJECTIVE To evaluate technical and methodological aspects of intraoperative spinal digital subtraction angiography (ISDSA) in our clinical practice and to assess its practicability, safety, and accuracy for the surgical treatment of spinal vascular malformations. METHODS Between August 1997 and February 2002, a total of 30 patients were treated either surgically (n = 18) or endovascularly (n = 12) for spinal vascular lesions at our institution. The clinical records of five patients who underwent ISDSA were analyzed retrospectively. The thoracic segment was involved in three patients and the medullary cone in two. RESULTS ISDSA could be performed in four cases. In one patient, the segmental artery could not be probed sufficiently while the patient was prone. No complications occurred from the application of ISDSA. The method was beneficial for the neurosurgeon in all but one patient because the vascular anatomy of the malformation was shown with respect to the surgical approach, including the nidus, and immediate resection control could be performed before wound closure. The duration of the procedure was prolonged by 45 minutes on average. CONCLUSION ISDSA is safe and effective, especially in surgery for complex vascular and recurrent malformations. Benefits to the patient outweigh the additional expense and prolongation of the surgical procedure.

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

2014 ◽  
Vol 121 (3) ◽  
pp. 745-750 ◽  
Author(s):  
David A. Stidd ◽  
Joshua Wewel ◽  
Ali J. Ghods ◽  
Stephan Munich ◽  
Anthony Serici ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Vascular Anatomy ◽  
Water Soluble ◽  
Vascular Lesions ◽  
Digital Subtraction ◽  
Cerebrovascular Lesions ◽  
Data Set ◽  
Surface Anatomy ◽  
Neuronavigation System ◽  
Image Set

Object Cerebrovascular lesions can have complicated abnormal anatomy that is not completely characterized by CT or MR angiography. Although 3D rotational angiography provides superior spatial and temporal resolution, catheter angiograms are not easily registered to the patient, limiting the use of these images as a source for neuronavigation. However, 3D digital subtraction angiography (DSA) contains not only vascular anatomy but also facial surface anatomy data. The authors report a novel technique to register 3D DSA images by using only the surface anatomy contained within the data set without having to fuse the DSA image set to other imaging modalities or use fiducial markers. Methods A cadaver model was first created to assess the accuracy of neuronavigation based on 3D DSA images registered by facial surface anatomy. A 3D DSA scan was obtained of a formalin-fixed cadaver head, with acquisitions of mask and contrast runs. The right common carotid artery was injected prior to the contrast run with a 45% contrast solution diluted with water-soluble red liquid latex. One week later, the head was registered to a neuronavigation system loaded with the 3D DSA images acquired earlier using facial surface anatomy. A right pterional craniotomy was performed and 10 different vascular landmarks were identified and measured for accuracy using the neuronavigation system. Neuronavigation based only on 3D DSA was then used to guide an open clipping procedure for a patient who presented with a ruptured distal lenticulostriate aneurysm. Results The accuracy of the measurements for the cadaver model was 0.71 ± 0.25 mm (mean ± SE), which is superior to the 1.8–5 mm reported for neuronavigation. The 3D DSA–based navigation-assisted surgery for the distal lenticulostriate aneurysm aided in localization, resulting in a small craniotomy and minimal brain dissection. Conclusions This is the first example of frameless neuronavigation based on 3D catheter angiography registered by only the surface anatomy data contained within the 3D DSA image set. This is an easily applied technique that is beneficial for accurately locating vascular pathological entities and reducing the dissection burden of vascular lesions.

scholarly journals Four-dimensional digital subtraction angiography for exploration of spinal cord vascular malformations: preliminary experience

2020 ◽  
Vol 13 (1) ◽  
pp. 69-74
Author(s):  
Frédéric Clarençon ◽  
Stéphanie Lenck ◽  
Eimad Shotar ◽  
Anne-Laure Boch ◽  
Etienne Lefevre ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Digital Subtraction ◽  
Drainage Pattern ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Precise Understanding ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

BackgroundThe precise understanding of the angioarchitecture of spinal vascular malformations (SVMs) is often difficult to reach with conventional digital subtraction angiography (DSA). The purpose of our study was to evaluate the potential of four-dimensional DSA (4D-DSA) (Siemens Healthcare) in the exploration of SVMs.MethodsWe retrospectively studied all patients who underwent spinal DSA, including 4D-DSA acquisition, from July 2018 to June 2019 at a single institution. All spinal DSA acquisitions were performed under general anesthesia. 4D-DSA acquisitions were acquired with the protocol '12 s DSA Dyna4D Neuro'. 12 mL of iodixanol 320 mg iodine/mL were injected via a 5 F catheter (1 mL/s during the 12 s 4D-DSA acquisition). Inter-rater (three independent reviewers) and intermodality agreements were assessed.ResultsNine consecutive patients (six men, three women, mean age 55.3±19.8 years) with 10 SVMs (spinal dural arteriovenous fistulas n=3, spinal epidural arteriovenous fistulas n=2, spinal pial arteriovenous fistulas n=2, and spinal arteriovenous malformations n=2; one patient had two synchronous pial fistulas) had spinal DSA, including 4D-DSA acquisition. Inter-rater agreement was good and moderate for the venous drainage pattern and the SVM subtype, respectively. In 9 of 10 cases, the quality of the acquisition was graded as good. Satisfactory concordance between 4D-DSA and the selective microcatheterization was observed in 90% of cases for the location of the shunt point.Conclusion4D-DSA acquisition may be helpful for a better understanding of the angioarchitecture of SVMs. Larger series are warranted to confirm these preliminary results.

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

1990 ◽  
Vol 73 (4) ◽  
pp. 526-533 ◽  
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.

scholarly journals Introduction: Spinal Vascular Malformations

2009 ◽  
Vol 26 (1) ◽  
pp. E1 ◽  
Author(s):  
Edward H. Oldfield
Keyword(s):  
Spinal Cord ◽  
Vascular Malformations ◽  
Vascular Lesions ◽  
Successful Management ◽  
Anatomical Features ◽  
Spinal Vascular Malformations ◽  
Cord Injury ◽  
Selective Arteriography ◽  
The 1960S ◽  
Made In

From the earliest observations of spinal vascular malformations, successful management has been challenging. Initially the challenges were diagnosing, understanding, and treating these lesions. They were originally considered all to be the same, or at least to be a single general type, of disease. With the introduction of selective spinal arteriography in the 1960s and more recently with the introduction and widespread use of MR imaging, the initial challenge of diagnosing spinal vascular malformations was overcome, and significant progress has been made in understanding their anatomy as well as the pathophysiology that underlies the myelopathy commonly associated with them. The anatomical features defined by selective arteriography and the observations permitted with the operating microscope ultimately led to distinctions between the major categories of the vascular lesions affecting the spinal cord; these distinctions were based on the lesions' anatomy, epidemiology, and the mechanism of spinal cord injury.

Volumetric T2-weighted MRI improves the diagnostic accuracy of spinal vascular malformations: comparative analysis with a conventional MR study

2019 ◽  
Vol 11 (10) ◽  
pp. 1019-1023 ◽  
Author(s):  
Santhosh Kumar Kannath ◽  
Adhithyan Rajendran ◽  
Bejoy Thomas ◽  
Jayadevan Enakshy Rajan
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Vascular Malformations ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Vascular Lesions ◽  
Volumetric Mri ◽  
Spinal Vascular Malformations ◽  
Sensitivity Specificity ◽  
T2 Mri

BackgroundTo date, very little study of the importance of a volumetric T2-weighted MR sequence in the evaluation of spinal vascular malformations (SVMs) has been carried out.ObjectiveTo determine the utility and accuracy of a volumetric T2 MR sequence compared with conventional T2 in the diagnosis of SVMs.MethodsRetrospective analysis of all patients who underwent spinal DSA for suspected SVMs was conducted. Conventional T2 and volumetric T2 MR images were analysed for the presence of flow voids and parenchymal changes, and SVMs were characterized. The sensitivity, specificity, and overall diagnostic accuracy of these MRI diagnoses were calculated.ResultsOf 89 subjects included in the final analysis, 70 patients had angiographically proved SVMs (38 patients with spinal cord arteriovenous malformations [SCAVM—intramedullary or perimedullary] and 32 cases of spinal dural arteriovenous fistula (SDAVF)) and the remaining 19 subjects were normal. The sensitivity and specificity for identification of SVMs were 98.1% and 90% for volumetric T2 sequences, compared with 82.8% and 89.4% for conventional T2 MRI, respectively. For characterization of spinal vascular lesions, volumetric MRI showed high sensitivity, specificity, and accuracy for SDAVF (100%, 90%, 97%, respectively) compared with conventional T2 MRI (71.8%, 89%, 79%, respectively). The positive likelihood ratio was high and negative likelihood ratio was zero for volumetric MRI evaluation of SDAVF, while these ratios were comparable between the two sequences for SCAVM.ConclusionVolumetric T2 MRI is highly sensitive for the detection of SVMs, especially for SDAVF. Volumetric T2 MRI could be introduced into routine clinical practice in the screening of suspected SVMs.

Preoperative imaging of cervical spine hemangioblastomas using three-dimensional fusion digital subtraction angiography

2006 ◽  
Vol 5 (1) ◽  
pp. 96-100 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Gaurav G. Mavinkurve ◽  
Philippe Gailloud ◽  
Ira M. Garonzik ◽  
Pablo F. Recinos ◽  
...  
Keyword(s):  
Cervical Spine ◽  
High Resolution ◽  
Preoperative Evaluation ◽  
Three Dimensional ◽  
Vascular Anatomy ◽  
Reconstruction Algorithm ◽  
Vascular Supply ◽  
Vascular Lesions ◽  
Preoperative Imaging ◽  
Digital Subtraction

✓ Angiography is often performed to identify the vascular supply of hemangioblastomas prior to resection. Conventional two-dimensional (2D) digital subtraction (DS) angiography and three-dimensional (3D) DS angiography provides high-resolution images of the vascular structures associated with these lesions. However, such 3D DS angiography often does not provide reliable anatomical information about nearby osseous structures, or when it does, resolution of vascular anatomy in the immediate vicinity of bone is sacrificed. A novel angiographic reconstruction algorithm was recently developed at The Johns Hopkins University to overcome these inadequacies. By combining two separate sequences of images of bone and blood vessels in a single 3D representation, 3D fusion DS (FDS) angiography provides precise topographic information about vascular lesions in relation to the osseous environment, without a loss of resolution. In this paper, the authors present the cases of two patients with cervical spine hemangioblastomas who underwent preoperative evaluation with FDS angiography and then successful gross-total resection of their tumors. In both cases, FDS angiography provided high-resolution 3D images of the hemangioblastoma anatomy, including each tumor’s topographic relationship with adjacent osseous structures and the location and size of feeding arteries and draining veins. These cases provide evidence that FDS angiography represents a useful adjunct to magnetic resonance imaging and 2D DS angiography in the preoperative evaluation and surgical planning of patients with vascular lesions in an osseous environment, such as hemangioblastomas in the spinal cord.

scholarly journals Balloon-assisted transarterial embolization of type 1 spinal dural arteriovenous fistula

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1
Author(s):  
Brian Lee ◽  
Vivek A. Mehta ◽  
William J. Mack ◽  
Matthew S. Tenser ◽  
Arun P. Amar
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Mri Imaging ◽  
Spinal Dural Arteriovenous Fistula ◽  
Lower Extremity Weakness ◽  
Segmental Artery ◽  
Spinal Vascular Malformations

Type 1 spinal dural arteriovenous fistula (dAVF) constitute the vast majority of all spinal vascular malformations. Here we present the case of a 71-year-old male with progressive myelopathy, lower-extremity weakness and numbness, and urinary incontinence. MRI imaging of the thoracic spine demonstrated cord edema, and catheter spinal angiography confirmed a type 1 spinal dAVF. The fistula was supplied by small dural branches of the left L-2 segmental artery. Angiographic cure was achieved with a one-stage procedure in which coils were used to occlude the distal segmental vessels, followed by balloon-assisted embolization with Onyx.The video can be found here: http://youtu.be/8aehJbueH0U.

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