Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy

Tang, Guoping; Cawley, C. Michael; Dion, Jacques E.; Barrow, Daniel L.

doi:10.3171/jns.2002.96.6.0993

Cited by 181 publications

(123 citation statements)

References 13 publications

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“…Als Konsequenz besteht ein anhaltendes Risiko für eine Ruptur, weitere Behandlungen können erforderlich werden [4]. In etwa 3-9% kann es zu einem Verschluss oder einer relevanten Einengung benachbarter Gefäße mit der Gefahr eines Hirninfarkts und bleibenden neurologischen Defiziten kommen [2,8].…”

Section: -73% Aller Mikrochirurgisch Versorgterunclassified

Rekonstruktionsoptimierung und Leistungsfähigkeit eines neurochirurgisch eingesetzten intraoperativen Flat-Panel-Systems

Röhrer¹,

König²,

Wirtz³

et al. 2015

OP-JOURNAL

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Zusammenfassung Die digitale Subtraktionsangiografie stellt den Goldstandard in der vaskul?ren Neurochirurgie dar. Durch die Anwendung einer intraoperativen Angiografie, welche durch den Hybridoperationssaal mit dem System Artis zeego m?glich ist, kann diese Kontrolle noch w?hrend der Operation, bei ge?ffnetem Sch?del durchgef?hrt werden. Unterschiedliche 2-D- und 3-D-Darstellungsm?glichkeiten der akquirierten Bilddaten machen es dem Operateur m?glich, die operative Strategie den daraus resultierenden Befunden ggf. anzupassen.

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Section: -73% Aller Mikrochirurgisch Versorgterunclassified

Rekonstruktionsoptimierung und Leistungsfähigkeit eines neurochirurgisch eingesetzten intraoperativen Flat-Panel-Systems

Röhrer¹,

König²,

Wirtz³

et al. 2015

OP-JOURNAL

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“…As 5-7.3% of surgically treated IA are unexpectedly incompletely occluded [Kivisaari et al 2004] and parent vessel occlusion occurs in 3-9% of cases Kumar and Friedman, 2009;Tang et al 2002], systematic IOA is expected to decrease these numbers. One group found an IA size exceeding 15 mm in maximum diameter independent predictor for clip revision, respective necessity of IOA [Tang et al 2002]. The nonuse of this tool as a routine procedure in treatment of IA in our centre is presumably based on wellestablished neurovascular treatment procedures and individual experience of surgeons and interventionalists.…”

Section: Indications For Iasmentioning

confidence: 99%

Treatment of complex neurovascular lesions: an interdisciplinary angio suite approach

Dammann

Breyer

Wrede

et al. 2013

Ther Adv Neurol Disord

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Objective: The objective of this study was to analyse our initial experience using an interdisciplinary angio suite approach to neurosurgical treatment of complex neurovascular lesions and expound technical feasibility and possible applications. Subjects: Six out of 451 patients with cranial or spinal neurovascular lesions were surgically treated in the angio suite (biplane angiographic system) during a 28-month observation period. Clinical baseline data, radiological and intraoperative findings as well as clinical and radiological outcome were assessed. Results: A ventral spinal perimedullary arteriovenous malformation, a ventral spinal perimedullary fistula, two diffuse frontal dural arteriovenous fistulas, a multifocal temporal arteriovenous malformation and a partially embolized fronto-temporo-basal dural arteriovenous fistula were successfully treated with angiographically confirmed complete occlusion and unimpaired neurological condition of the patients at the 12-month follow up. Conclusion: This study demonstrates the feasibility of this approach and points out possible indications, namely ventrally located spinal lesions and diffuse, deep seated cranial lesions.

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“…5 This approach with axial CTA but with limited coverage would be well suited for immediate postoperative imaging and has the potential to eliminate the need for a postoperative conventional angiogram. Although this approach does require accurate determination of the scan coverage, this can be easily done with use of the clip itself based on the scout view and would not require physician interaction.…”

Section: Figmentioning

confidence: 99%

Nonhelical Acquisition CT Angiogram after Aneurysmal Clipping: In Vitro Testing Shows Diminished Artifact

Mamourian¹,

Erkmen²,

Pluta³

2008

AJNR Am J Neuroradiol

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SUMMARY:Imaging of the cerebral vessels with use of CT angiogram (CTA) after placement of aneurysmal clips is often limited by clip artifacts. We used a phantom to demonstrate a visible reduction in metal artifact when using the axial technique, compared with the usual CTA helical acquisition. This approach may have some advantage when used for CTA with 64-section scanners in the specific circumstance of immediate postoperative imaging after placement of cerebral aneurysmal clips. CT angiogram (CTA) is an attractive alternative for patients who require imaging of the cerebral vasculature after aneurysm clipping compared with conventional angiography. Although advances in CT technology and the use of titanium clips have improved the quality of CTA after aneurysmal clipping, artifacts arising from the clip limit the visualization of the aneurysmal neck and nearby vessels in some cases.1 CTA usually requires the use of helical image acquisition, to provide rapid imaging with sufficient coverage, but it is of interest to consider that CT imaging of the brain at most sites is done with the axial technique because, in principle, it has fewer artifacts. 2 We wondered if axial imaging might improve the quality of CTA after placement of aneurysmal clips. This report describes the results of our study with use of a clipped aneurysmal phantom in which we compared the artifacts using the helical and axial techniques. Case Report/TechniqueWe studied silicone models of aneurysms in both a simple water bath and inside a skull to simulate the beam hardening that occurs in vivo. We immersed the skull in a bucket of tap water for imaging. These silicon phantoms were filled with dilute contrast (1 mL of Omnipaque 350 [GE Healthcare, Piscataway, NJ] mixed in 9 mL of saline). We studied all of the aneurysmal phantoms with a 64-section scanner (GE Healthcare, Milwaukee, Wis) using our postclipping CTA technique (ie, kV, 140; mA, 380; section collimation, 0.625 mm; pitch, 0.96; rotation speed, 0.4 seconds). These were compared with scans with use of the axial technique with a single rotation with 32 detectors collimated to 0.625 mm with a total coverage of 2 cm. Images were reconstructed for both techniques at a 0.625-mm interval (no overlap).We used commercially available titanium and cobalt alloy clips. Titanium is known to have fewer artifacts on CT than cobalt alloy clips.3 A Yasargil (Aesculap, Center Valley, Pa) 7-mm curved blade titanium clip and a 6-mm curved Sugita (Mizuho America, Beverly, Mass) cobalt alloy clip were positioned on the neck of the phantom aneurysm for the testing in the skull, and a titanium Sugita 7-mm blade straight clip was used for the experiments in the water bath. Test 1.We compared the images of a phantom 10-mm aneurysm in a water bath that had been clipped with a single titanium Sugita clip using both helical and axial imaging techniques.Test 2. The silicon aneurysm model in the skull was imaged with 1 Sugita cobalt alloy clip positioned on the neck of the aneurysm. We obtained axial and helical imag...

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Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy

Cited by 181 publications

References 13 publications

Rekonstruktionsoptimierung und Leistungsfähigkeit eines neurochirurgisch eingesetzten intraoperativen Flat-Panel-Systems

Rekonstruktionsoptimierung und Leistungsfähigkeit eines neurochirurgisch eingesetzten intraoperativen Flat-Panel-Systems

Treatment of complex neurovascular lesions: an interdisciplinary angio suite approach

Nonhelical Acquisition CT Angiogram after Aneurysmal Clipping: In Vitro Testing Shows Diminished Artifact

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