Intraoperative angiography in the surgical treatment of cerebral arteriovenous malformations and fistulas

Yanaka, Kiyoyuki; Matsumaru, Yuji; Okazaki, Masao; Noguchi, Shozo; Asakawa, Hiroyuki; Anno, Izumi; Nose, Tadao

doi:10.1007/s00701-003-0017-2

Cited by 23 publications

(12 citation statements)

References 21 publications

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“…DSA is the gold standard procedure to confirm the complete obliteration of neurovascular pathologies such as aneurysms, arteriovenous malformations (AVM) and dural arteriovenous fistulas (dAVF). 2,4,8,22 Often, it is most helpful to perform the angiogram intra-operatively, to confirm elimination prior to the completion of the surgery. In cases when the patient is positioned supine, femoral artery access is easily obtained.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative angiography via the popliteal artery: a useful technique for patients in the prone position

Villelli

Lewis

Leipzig

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEIntraoperative angiography can be a valuable tool in the surgical management of vascular disorders in the CNS. This is typically accomplished via femoral artery puncture; however, this can be technically difficult in patients in the prone position. The authors describe the feasibility of intraoperative angiography via the popliteal artery in the prone patient.METHODSThree patients underwent intraoperative spinal angiography in the prone position via vascular access through the popliteal artery. Standard angiography techniques were used, along with ultrasound and a micropuncture needle for initial vascular access. Two patients underwent intraoperative angiography to confirm the obliteration of dural arteriovenous fistulas. The third patient required unexpected intraoperative angiography when a tumor was concerning for a vascular malformation in the cervical spine.RESULTSAll 3 patients tolerated the procedure without complication. The popliteal artery was easily accessed without any adaptation to typical patient positioning for these prone-position cases. This proved particularly beneficial when angiography was not part of the preoperative plan.CONCLUSIONSIntraoperative angiography via the popliteal artery is feasible and well tolerated. It presents significant benefit when obtaining imaging studies in patients in a prone position, with the added benefit of easy access, familiar anatomy, and low concern for catheter thrombosis or kinking.

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Section: Discussionmentioning

confidence: 99%

Intraoperative angiography via the popliteal artery: a useful technique for patients in the prone position

Villelli

Lewis

Leipzig

et al. 2018

Journal of Neurosurgery: Spine

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“…In the series from Barrow and colleagues surgery was altered in seven out of 39 cerebral (18%) and two out of three spinal (67%) AVMs [Barrow et al 1992]. Yanaka and colleagues reported alteration of surgery in one out of 20 (5%) cerebral AVMs [Yanaka et al 2003], Martin and colleagues reported alteration of surgery in five out of 50 (10%) cerebral AVMs [Martin et al 1990] and Vitaz and colleagues reported alteration of surgery in 28 out of 98 (29%) cerebral AVMs [Vitaz et al 1999]. Chalouhi and colleagues reported that IOA revealed residual nidus, respective fistula, in eight out of 97 (8.2%) cerebral AVMs and three out of 18 (18.8%) cerebral dAVFs [Chalouhi et al 2012].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a systematic superiority in using IOA compared with the established standard procedures, although being claimed for cerebral aneurysm surgery [Friedman and Kumar, 2009], has not been proven so far. Nevertheless, evidence from single series [Barrow et al 1992; Martin et al 1990; Raabe et al 2006; Vitaz et al 1999; Yanaka et al 2003] and our own experience suggest that in some cases of neurovascular lesions, IOA can be regarded as helpful or, moreover, an absolute requirement for a successful surgical treatment. In such cases, we decide to perform surgery using a ‘tailored’ angio suite solution in our institution.…”

Section: Introductionmentioning

confidence: 90%

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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“…Numerous feeders can supply the nidus from the deep side, and these feeders may be blocked by brain parenchyma. Such a complex nature means that DSA remains the gold standard for evaluation (52), but it is not always available.…”

Section: Clinical Application Of Fna Videoangiography In Vascular Neumentioning

confidence: 99%

Application of Fluorescein Fluorescence in Vascular Neurosurgery

et al. 2019

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Background: Fluorescein sodium (FNa) is a fluorescent drug with a long history of use for assessing retinal blood flow in ophthalmology; however, its application in vascular neurosurgery is only now gaining popularity. This review summarizes the current knowledge about using FNa videoangiography in vascular neurosurgery.Methods: We performed a literature review on the usage of FNa for fluorescent videoangiography procedures in neurosurgery. We analyzed methods of injection, dosages of FNa, visualizing platforms, and interpretation of FNa videoangiography. We also reviewed practical applications of FNa videoangiography during various vascular neurosurgeries.Results: FNa videoangiography can be performed with intraarterial (intracarotid) or intravenous dye injections. Both methods provide excellent resolution with enhanced fluorescence that shows intravascular blood flow on top of visible surrounding anatomy, and both allow simultaneous purposeful microsurgical manipulations. Although it is invasive, an intracarotid FNa injection results in faster contrast appearance and higher-intensity fluorescence and requires a lower dose per injection (reported range, 1–50 mg) compared with peripheral intravenous FNa injection (reported range, 75–2,000 mg or 1–1.5 mg/kg body weight). Four optical excitation/detection tools for FNa videoangiography have been successfully used: conventional xenon-light operating microscope with a special filter set, pencil-type light-emitting diode probe with a filter set, laser-illumination operating microscope, and an endoscope with a filter set. FNa videoangiography was reported to be feasible and useful in various clinical scenarios, such as examining the feeders and drainers in arteriovenous malformation surgery, checking the patency of a microvascular anastomosis, and assessing blood flow during aneurysm clipping. FNa videoangiography can be repeated during the same procedure and used along with indocyanine green (ICG) videoangiography.Conclusions: Compared with ICG videoangiography, FNa videoangiography has the advantages of enabling real-time inspection and better visualization at deep locations; however, thick vessel walls limit visualization of FNa in larger vessels. FNa videoangiography is a useful tool in multiple neurovascular scenarios and merits further studies to establish its clinical value.

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Intraoperative angiography in the surgical treatment of cerebral arteriovenous malformations and fistulas

Cited by 23 publications

References 21 publications

Intraoperative angiography via the popliteal artery: a useful technique for patients in the prone position

Intraoperative angiography via the popliteal artery: a useful technique for patients in the prone position

Treatment of complex neurovascular lesions: an interdisciplinary angio suite approach

Application of Fluorescein Fluorescence in Vascular Neurosurgery

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