The Angle of the Microguidwire on the Lateral Projection: a Prediction of Cannulation of the Occluded Inferior Petrosal Sinuses for the Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistulas

OBJECTIVE: To describe that the angle of the guidwire on lateral projection under fluoroscopic image is a prediction of cannulation of the occluded inferior petrosal sinus in the transvenous embolization of cavernous sinus dural fistulas.METHODS: From January 2018 through January 2021, 12 consecutive cavernous sinus dural fistulas with ipsilateral inferior petrosal sinus occlusion identified in 12 patients were cured by cannulation of the occluded ipsilateral inferior petrosal sinus. Clinical, radiologic and procedure data of the 12 patients were retrospectively reviewed. The angle of microguidewire between on lateral projection under fluoroscopic image between the inferior petrosal sinus and the internal jugular vein was measured by 180°Protractor(Deli Group Co., LTD, Zhejiang, China). RESULTS: In the 12 patients, access via the occluded ipsilateral inferior petrosal sinus was primarily attempted as the transvenous approach. During the procedure, the angle of microguidwire on lateral projection under fluoroscopic image between the inferior petrosal sinus and the internal jugular vein was 117°±7°, which is very useful to confirm the cannulation of the occluded inferior petrosal sinus. Complete occlusion was achieved in all fistulas, with no procedure-related morbidity or mortality. Postprocedural symptom was improved in all patients. CONCLUSION: Cannulation of an occluded inferior petrosal sinus is possible and reasonable as an initial access attempt for cavernous sinus dural fistulas. The angle of microguidwire on the lateral projection under fluoroscopic image can help to confirm the orifice of the occluded inferior petrosal sinus.

A compact and mobile hybrid C-arm scanner for simultaneous nuclear and fluoroscopic image guidance

Purpose This study evaluates the performance of a mobile and compact hybrid C-arm scanner (referred to as IXSI) that is capable of simultaneous acquisition of 2D fluoroscopic and nuclear projections and 3D image reconstruction in the intervention room. Results The impact of slightly misaligning the IXSI modalities (in an off-focus geometry) was investigated for the reduction of the fluoroscopic and nuclear interference. The 2D and 3D nuclear image quality of IXSI was compared with a clinical SPECT/CT scanner by determining the spatial resolution and sensitivity of point sources and by performing a quantitative analysis of the reconstructed NEMA image quality phantom. The 2D and 3D fluoroscopic image of IXSI was compared with a clinical CBCT scanner by visualizing the Fluorad A+D image quality phantom and by visualizing a reconstructed liver nodule phantom. Finally, the feasibility of dynamic simultaneous nuclear and fluoroscopic imaging was demonstrated by injecting an anthropomorphic phantom with a mixture of iodinated contrast and 99mTc. Conclusion Due to the divergent innovative hybrid design of IXSI, concessions were made to the nuclear and fluoroscopic image qualities. Nevertheless, IXSI realizes unique image guidance that may be beneficial for several types of procedures. Key Points • IXSI can perform time-resolved planar (2D) simultaneous fluoroscopic and nuclear imaging. • IXSI can perform SPECT/CBCT imaging (3D) inside the intervention room.

Robust Catheter Tracking by Fusing Electromagnetic Tracking, Fiber Bragg Grating and Sparse Fluoroscopic Images

<p>In this paper, we propose a novel method to improve the shape sensing accuracy of FBG for catheter by fusing FBG-based sensed shape with sparse fluoroscopic images. The main advantage of the new proposed method compared to other methods are the limited number in fluoroscopic image used during procedure while it still maintains high precision real-time 3D visualization of the catheter. To demonstrate the performance of the proposed method 2D and 3D dynamic experiments were carried out and they shows promising results. For a catheter with an embedded fiber length of 170 mm, the proposed approach can reconstruct the 3D shape with a median root mean square error of 0.54 mm were seen in the 3D experiments compared to the traditional approach of using FBG alone of 0.86 mm.</p>

Robust Catheter Tracking by Fusing Electromagnetic Tracking, Fiber Bragg Grating and Sparse Fluoroscopic Images

<p>In this paper, we propose a novel method to improve the shape sensing accuracy of FBG for catheter by fusing FBG-based sensed shape with sparse fluoroscopic images. The main advantage of the new proposed method compared to other methods are the limited number in fluoroscopic image used during procedure while it still maintains high precision real-time 3D visualization of the catheter. To demonstrate the performance of the proposed method 2D and 3D dynamic experiments were carried out and they shows promising results. For a catheter with an embedded fiber length of 170 mm, the proposed approach can reconstruct the 3D shape with a median root mean square error of 0.54 mm were seen in the 3D experiments compared to the traditional approach of using FBG alone of 0.86 mm.</p>

Management of symptomatic disc herniation in pregnancy: A case report and literature review

Background: Lower back pain with radiculopathy due to a disc herniation occurs in about 0.01% of pregnant females. Surgical intervention is seldom required unless there is intractable pain, and for a significant neurological deficit. Further, the use of intraoperative ionizing radiation may adversely affect the developing fetus. Case Description: A 25-year-old female, 17-weeks pregnant, presented with right lower extremity sciatica due to a L4-5 unilateral disc herniation. She underwent a microdiscectomy that required just one intraoperative C-arm fluoroscopic image. Postoperatively, her leg pain resolved, and she delivered a healthy baby at term. Conclusion: Using single-image C-arm fluoroscopy in a pregnant female undergoing an emergent lumbar discectomy, employing as low as reasonably achievable/shielding, did not adversely impact the developing fetus.