TY - JOUR
T1 - Intra-arterial intraoperative computed tomography angiography guided navigation
T2 - A new technique for localization of vascular pathology
AU - Raza, Shaan M.
AU - Papadimitriou, Kyriakos
AU - Gandhi, Dheeraj
AU - Radvany, Martin
AU - Olivi, Alessandro
AU - Huang, Judy
PY - 2012/12
Y1 - 2012/12
N2 - BACKGROUND:: Precise intraoperative surgical localization of small distal aneurysms, arteriovenous malformations (AVMs), and cranial base dural arteriovenous fistulae may be challenging. Current neuronavigational techniques are based on imaging techniques with limited sensitivity to detect vascular lesions that are small. We introduce the technique of intraoperative computed tomography angiography (iCTA) with an intra-arterial injection for surgical navigation. OBJECTIVE:: To determine whether iCTA integrated with a navigation platform is accurate and useful for precise localization of small vascular lesions that are challenging to treat. METHODS:: This study included 8 patients: 2 with aneurysms, 3 with small cortical AVMs, and 3 with cranial base dural arteriovenous fistulae. iCTA with intra-arterial contrast injection was performed in all patients for precise localization of the small vascular lesion to facilitate craniotomy planning and microsurgical approach. All operative reports, inpatient and outpatient records, and radiographic studies available were reviewed retrospectively. RESULTS:: The iCTA was used to target 2 aneurysms, 3 small subcortical AVMs, and 3 dural arteriovenous fistulae. This technique was most helpful to localize the 3 AVMs and the distal M4 aneurysm precisely. Craniotomy planning was accurate in all instances; no complications related to the technique were noted, and all patients had uneventful postoperative recoveries. CONCLUSION:: iCTA is an effective and accurate novel technique that can enhance the safety of surgical treatment for small intra-axial vascular pathology.
AB - BACKGROUND:: Precise intraoperative surgical localization of small distal aneurysms, arteriovenous malformations (AVMs), and cranial base dural arteriovenous fistulae may be challenging. Current neuronavigational techniques are based on imaging techniques with limited sensitivity to detect vascular lesions that are small. We introduce the technique of intraoperative computed tomography angiography (iCTA) with an intra-arterial injection for surgical navigation. OBJECTIVE:: To determine whether iCTA integrated with a navigation platform is accurate and useful for precise localization of small vascular lesions that are challenging to treat. METHODS:: This study included 8 patients: 2 with aneurysms, 3 with small cortical AVMs, and 3 with cranial base dural arteriovenous fistulae. iCTA with intra-arterial contrast injection was performed in all patients for precise localization of the small vascular lesion to facilitate craniotomy planning and microsurgical approach. All operative reports, inpatient and outpatient records, and radiographic studies available were reviewed retrospectively. RESULTS:: The iCTA was used to target 2 aneurysms, 3 small subcortical AVMs, and 3 dural arteriovenous fistulae. This technique was most helpful to localize the 3 AVMs and the distal M4 aneurysm precisely. Craniotomy planning was accurate in all instances; no complications related to the technique were noted, and all patients had uneventful postoperative recoveries. CONCLUSION:: iCTA is an effective and accurate novel technique that can enhance the safety of surgical treatment for small intra-axial vascular pathology.
KW - Arteriovenous malformation
KW - Cerebral aneurysm
KW - Computed tomography angiography
KW - Dural arteriovenous fistula
KW - Intraoperative imaging
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U2 - 10.1227/NEU.0b013e3182647a73
DO - 10.1227/NEU.0b013e3182647a73
M3 - Article
C2 - 22858682
AN - SCOPUS:84870297385
SN - 0148-396X
VL - 71
SP - ons240-ons252
JO - Neurosurgery
JF - Neurosurgery
IS - SUPPL.2
ER -