Real-Time Image Guidance for Open Vascular Neurosurgery Using Digital Angiographic Roadmapping

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-55-ONS-62 ◽  
Author(s):  
Michael Ayad ◽  
Arthur J. Ulm ◽  
Tom Yao ◽  
Eric Eskioglu ◽  
Robert A. Mericle
Keyword(s):  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Computed Tomographic Angiography ◽  
Vascular Lesion ◽  
Skin Wound ◽  
Vascular Lesions ◽  
Frameless Stereotaxy ◽  
Image Guided ◽  
Navigation Tool ◽  
Spinal Arteriovenous Malformations

Abstract Objective: Angiographic roadmapping, commonly used for catheter navigation in endovascular procedures, is the superimposition of a live fluoroscopic image on a previously stored digitally subtracted angiogram. We evaluated this technique for the first time as a method for image-guided navigation during surgical resection of intracranial and spinal vascular lesions. Methods: After obtaining Institutional Review Board approval, we retrospectively reviewed 38 procedures in 35 patients at two centers performed by one neurosurgeon in which intraoperative roadmapping was used as an image-guided navigation tool for surgical resection of cranial and spinal arteriovenous malformations or fistulae. This technique requires femoral or radial artery access and a portable vascular C-arm capable of digitally subtracted angiogram and roadmap angiography in the operating room suite. Once a roadmap identifying the vascular lesion is obtained, a sterile radiopaque instrument is placed over the skin/wound to precisely localize the lesion in multiple dimensions. Results: Angiographic roadmapping was used for resection of seven spinal arteriovenous malformations or fistulae, 23 cranial arteriovenous malformations or fistulae, one aneurysm, two carotid-cavernous fistulae, and transtorcular embolization of five vein of Galen malformations. In all cases, the technique helped us to make precisely localized incisions, avoid unnecessary bone removal, and readily directed us to the vascular lesion. In several cases, it allowed localization of small fistulae not visible on magnetic resonance imaging or computed tomographic angiography scans. Finally, this approach facilitated immediate angiographic confirmation of complete resection at the end of each case. Conclusion: Angiographic roadmapping is an effective intraoperative navigation tool for resection of vascular lesions that has not been previously described and offers several advantages to frameless stereotaxy.

Surgical Management Of Posterior Fossa Arteriovenous Malformations

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-189-ONS-201 ◽  
Author(s):  
John Sinclair ◽  
Michael E. Kelly ◽  
Gary K. Steinberg
Keyword(s):  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cranial Nerves ◽  
Venous Drainage ◽  
Cerebellar Nuclei ◽  
Preoperative Embolization ◽  
Frameless Stereotaxy ◽  
Microsurgical Resection

Abstract Objective: Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage. Methods: Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei. Results: Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality. Conclusion: Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.

Intraoperative color-flow Doppler imaging of AVM's and aneurysms

1988 ◽  
Vol 68 (4) ◽  
pp. 635-639 ◽  
Author(s):  
Keith L. Black ◽  
Jonathan M. Rubin ◽  
William F. Chandler ◽  
John E. McGillicuddy
Keyword(s):  
Arteriovenous Malformations ◽  
Doppler Sonography ◽  
Giant Aneurysm ◽  
Surgical Excision ◽  
Doppler Imaging ◽  
Vascular Lesions ◽  
Color Flow ◽  
Content Type ◽  
Color Flow Doppler Sonography ◽  
Spinal Arteriovenous Malformations

✓ The use of intraoperative color-flow Doppler sonography to image cerebral and spinal arteriovenous malformations (AVM's) and a giant aneurysm is reported in 10 patients. The technique is a useful adjunct in localizing vascular lesions, identifying feeding or draining vessels, and confirming intraoperative surgical excision of AVM's or ligation of giant aneurysms. Imaging of lesions deeper than 4 to 5 cm is, however, limited with the equipment design now commercially available.

Microsurgical management of glomus spinal arteriovenous malformations: pial resection technique

2012 ◽  
Vol 16 (6) ◽  
pp. 523-531 ◽  
Author(s):  
Gregory J. Velat ◽  
Steve W. Chang ◽  
Adib A. Abla ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Signs And Symptoms ◽  
Vascular Lesions ◽  
Morbidity Rate ◽  
Surgical Morbidity ◽  
Surgical Interventions ◽  
Spinal Arteriovenous Malformations

Object Intramedullary, or glomus, spinal arteriovenous malformations (AVMs) are rare vascular lesions amenable to resection with or without adjuvant embolization. The authors retrospectively reviewed the senior author's (R.F.S.'s) surgical series of intramedullary spinal AVMs to evaluate clinical and radiographic outcomes. Methods Detailed chart and radiographic reviews were performed for all patients with intramedullary spinal AVMs who underwent surgical treatment between 1994 and 2011. Presenting and follow-up neurological examination results were obtained and graded using the modified Rankin Scale (mRS) and McCormick Scale. Surgical technique, outcomes, complications, and long-term angiographic studies were reviewed. Results During the study period, 20 patients (10 males and 10 females) underwent resection of glomus spinal AVMs. The mean age at presentation was 30 ± 17 years (range 7–62 years). The location of the AVMs was as follows: cervical spine (n = 10), thoracic spine (n = 9), and cervicothoracic junction (n = 1). The most common presenting signs and symptoms included paresis or paralysis (65%), paresthesias (40%), and myelopathy (40%). Perioperative embolization was performed in the majority (60%) of patients. Pial AVM resection was performed in 17 cases (85%). Angiographically verified AVM obliteration was achieved in 15 patients (75%). At a mean follow-up duration of 45.4 ± 52.4 months (range 2–176 months), 14 patients (70%) remained functionally independent (mRS and McCormick Scale scores ≤ 2). One perioperative complication occurred, yielding a surgical morbidity rate of 5%. Three symptomatic spinal cord tetherings occurred at a mean of 5.7 years after AVM resection. No neurological decline was observed after endovascular and surgical interventions. No deaths occurred. Long-term angiographic follow-up data were available for 9 patients (40%) at a mean of 67.6 ± 60.3 months (range 5–176 months) following AVM resection. Durable AVM obliteration was documented in 5 (83%) of 6 patients. Conclusions Intramedullary AVMs may be safely resected with satisfactory clinical and angiographic results. The pial resection technique, which provides subtotal AVM nidus resection, effectively devascularized these lesions, as confirmed on postoperative angiography, without violating the spinal cord parenchyma, thereby potentially reducing iatrogenic injury.

scholarly journals Interactive Image-Guided Surgical Resection of Intracranial Arteriovenous Malformations

1998 ◽  
Vol 3 (2) ◽  
pp. 57-63 ◽  
Author(s):  
Lucia Zamorano ◽  
Amgad Matter ◽  
Arturo Saenz ◽  
Genges Portillo ◽  
Fernando Diaz
Keyword(s):  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations ◽  
Image Guided

scholarly journals National trends in spinal arteriovenous malformations

2009 ◽  
Vol 26 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Shivanand P. Lad ◽  
Justin G. Santarelli ◽  
Chirag G. Patil ◽  
Gary K. Steinberg ◽  
Maxwell Boakye
Keyword(s):  
Hospital Stay ◽  
Arteriovenous Malformations ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Endovascular Embolization ◽  
Outcome Data ◽  
Vascular Lesions ◽  
Hospital Treatment ◽  
Management Options ◽  
Spinal Arteriovenous Malformations

Object Spinal arteriovenous malformations (AVMs) are rare and understudied vascular lesions that cause neurological insult by mass effect, venous obstruction, and vascular steal. These lesions are challenging entities to treat because of their complicated anatomy and physiology. Current management options include open microsurgery, endovascular embolization, and stereotactic radiosurgery. Methods Our study used the National Inpatient Sample database to analyze outcome data for spinal AVMs treated nationwide over an 11-year period from 1995 through 2006. Trends in procedural management, hospital course, and epidemiology of spinal AVMs are investigated. Results Annually, an average of 300 patients presented with spinal AVMs requiring hospital treatment. The average length of hospital stay for this treatment has declined from more than 9 days in 1995 to 6 days in 2006. However, the average cost of a hospital stay has increased from < $30,000 to nearly $70,000. Whereas one-half of spinal AVMs were treated operatively in 1995, one-third were managed operatively in 2006. Conclusions Spinal AVMs are being increasingly treated by endovascular, radiosurgical, or combined means. A discussion of modern strategies to treat these disorders is presented.

Image-Guided Resection of Embolized Cerebral Arteriovenous Malformations Based on Catheter-Based Angiography

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 471-475 ◽  
Author(s):  
L. Fernando Gonzalez ◽  
Felipe C. Albuquerque ◽  
Sirjic Boom ◽  
Bradford S. Burling ◽  
Stephen M. Papadopoulos ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Image Guidance ◽  
Computed Tomographic Angiography ◽  
3 Dimensional ◽  
Computed Tomographic ◽  
Guided Surgery ◽  
Image Guided ◽  
Single Method ◽  
Tomographic Angiography ◽  
Excellent Accuracy

Abstract OBJECTIVE We introduce a technique that enables the use of catheter angiography during image-guided surgery for the resection of previously embolized arteriovenous malformations. METHODS We used models to test the possibility of matching specific anatomic points 1:1 and the accuracy of merging catheter-based 3-dimensional angiography with standard computed tomographic angiography. RESULTS After obtaining excellent accuracy matching the 2 modalities, we merged both studies into the image-guidance platform. After embolizing a patient's arteriovenous malformation with Onyx, we successfully used the merged study to navigate during surgical resection of the lesion. No complications resulted from this technique, which increases contrast by only 15 cm3 and radiation exposure by 4 seconds. CONCLUSION Catheter-based angiography can be used during image guidance to reduce the artifact from metal particles after embolization. Excellent accuracy was obtained in merging 3-dimensional angiography with computed tomographic angiography. Further studies are needed to evaluate catheter-based 3-dimensional angiography as a single method for navigation during neurovascular surgery.

scholarly journals Urticarial reaction following endovascular embolization of an orbital arteriovenous malformation (AVM) with n-butyl cyanoacrylate (nBCA) glue

2017 ◽  
Vol 23 (6) ◽  
pp. 666-668 ◽  
Author(s):  
Kunal R Sinha ◽  
Gary Duckwiler ◽  
Daniel B Rootman
Keyword(s):  
Arteriovenous Malformation ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Vascular Inflammation ◽  
Endovascular Embolization ◽  
Vascular Lesions ◽  
Hypersensitivity Reactions ◽  
Potential Complication ◽  
Skin Allergy ◽  
Systemic Hypersensitivity

Orbital arteriovenous malformations (AVMs) are rare vascular lesions that may be managed with endovascular embolization followed by surgical resection. Embolization is often accomplished with n-butyl-2-cyanoacrylate (nBCA), which is considered to be a safe and effective liquid occlusive agent. Localized vascular inflammation has been associated with endovascular nBCA use in histopathologic studies, but reports of systemic hypersensitivity reactions following endovascular embolization with nBCA are rare. We present a case of a 26-year-old male who developed an intermittent systemic urticarial reaction without cardiopulmonary compromise beginning four weeks after nBCA embolization of an orbital AVM. Subsequent skin allergy testing performed by an allergist confirmed hypersensitivity to nBCA glue and the patient has since been successfully managed with daily oral antihistamines. Awareness of this rare potential complication of endovascular embolization with nBCA will aid in the counseling and management of patients with AVMs.

Glomangiopericytoma of the sphenoethmoid complex

2020 ◽  
Vol 13 (12) ◽  
pp. e236048
Author(s):  
Larry Shemen ◽  
Wayne Yan ◽  
Adnan Hasanovic ◽  
Jiankun Tong
Keyword(s):  
Surgical Resection ◽  
World Literature ◽  
Vascular Lesion ◽  
Common Type ◽  
Optimal Treatment ◽  
Rare Tumour ◽  
Complete Surgical Resection ◽  
The World

Sinonasal glomangiopericytoma is a rare sinonasal tumour accounting for less than. 5% of all sinonasal tumours. This tumour often presents as another, more common type of vascular lesion and is similarly prone to haemorrhage. The optimal treatment includes complete surgical resection. We, herein, present two such cases adding to the world literature of this rare tumour.

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