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

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.

scholarly journals The Role Of Decompressive Hemnicraniectomies As Damage Control For Ruptured Intracranial Arteriovenous Malformations

2021 ◽  
pp. 101270
Author(s):  
Raphael Bertani ◽  
Stefan W. Koester ◽  
Karl R. Abi-Aad ◽  
Anna R. Kimata ◽  
Kevin L. Ma ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Damage Control ◽  
Intracranial Arteriovenous Malformations

scholarly journals Recurrent Chordoma Resection in the Advanced Multimodality Image Guided Operating Suite: 2-Dimensional Operative Video

2021 ◽  
Vol 20 (5) ◽  
pp. E344-E345
Author(s):  
Walid Ibn Essayed ◽  
Kaith K Almefty ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Surgical Resection ◽  
Petrous Apex ◽  
Tumor Control ◽  
Image Guided ◽  
Endoscopy Ultrasound ◽  
Radiation Induced ◽  
Multimodality Image ◽  
The Right ◽  
Operating Suite

Abstract Recurrent skull base chordomas are challenging lesions. They already had maximum radiation, and in the absence of any effective medical treatment, surgical resection is the only treatment.1,2 Surgery on recurrent previously radiated chordomas, however, carries much higher risk and the likelihood of subtotal resection. Maximizing tumor resection allows longer tumor control.3-5 The Advanced Multimodality Image Guided Operating Suite developed at the Brigham and Women's Hospital, Harvard Medical School, with the support of the National Institutes of Health, provides an optimal environment to manage these tumors. It offers the capability to obtain and integrate multiple modalities during surgery, including magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT), endoscopy, ultrasound, fluoroscopy, and the ability to perform emergent endovascular procedures.5-7 The patient is a 39-yr-old male, presenting after 19 yr follow-up of a surgical resection and proton beam treatment for a skull base chordoma. He developed progressive ophthalmoplegia due to recurrence of his chordoma at the right petrous apex and cavernous sinus. Preoperative angiography demonstrated narrowing of the petrous segment of the right carotid artery suspect of radiation-induced angiopathy. The presence of radiation-induced angiopathy increases the risk of intraoperative carotid rupture, and the availability of endovascular intervention in the operative suite added favorable preparedness to deal with such complications if they happen. Given the clinical and radiological progression, surgical intervention was carried out through the prior zygomatic approach with the goal of performing maximum resection.8 The patient had an uneventful postoperative course and remained stable until he had a second recurrence 4 yr later. The patient consented to the procedure.

scholarly journals Techniques of Onyx Embolization of Arteriovenous Malformation: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kathryn M Wagner ◽  
Visish M Srinivasan ◽  
Peter Kan
Keyword(s):  
Informed Consent ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Great Care ◽  
Endovascular Techniques ◽  
Definitive Therapy ◽  
Feeding Vessels ◽  
Multiple Feeding ◽  
Staged Treatment

Abstract Advances in endovascular techniques and tools have allowed for treatment of complex arteriovenous malformations (AVMs), which historically may have posed unacceptable risk for open surgical resection. Endovascular treatment may be employed as an adjunct to surgical resection or as definitive therapy. Improvements in embolization materials have made endovascular AVM treatment safer for patients and useful across a variety of lesions. While many techniques are employed for transarterial AVM embolization, the essential tenets apply to all procedures: (1) great care should be taken to cannulate only vessels directly supplying the lesion, and not en passage vessels, prior to injecting embolisate; (2) embolisate should travel into the nidus, but not into the draining veins; (3) embolistate reflux proximal to the microcatheter should be avoided. There are several techniques that accomplish these goals, including the plug and push method, or using a balloon to prevent embolisate reflux. We use controlled injection of liquid Onyx (Medtronic), with increasing pressure over multiple injections pushing the embolisate forward into the AVM. This is repeated in multiple feeding vessels to decrease or eliminate supply to the AVM. Here, we present a 36-yr-old female with a right parietal AVM discovered on workup of headaches. After informed consent was obtained, she underwent preoperative embolization using this technique prior to uncomplicated surgical resection. The video shows the endovascular Onyx embolization of multiple feeding vessels over staged treatment.

Repeat stereotactic radiosurgery for high-grade and large intracranial arteriovenous malformations

2007 ◽  
Vol 68 (1) ◽  
pp. 24-34 ◽  
Author(s):  
Shaan M. Raza ◽  
Salma Jabbour ◽  
Quoc-Anh Thai ◽  
Gustavo Pradilla ◽  
Lawrence R. Kleinberg ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
High Grade ◽  
Intracranial Arteriovenous Malformations

Intraoperative angiography in the resection of arteriovenous malformations

1994 ◽  
Vol 80 (1) ◽  
pp. 73-78 ◽  
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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