Intraoperative spinal digital subtraction angiography: indications, technique, safety, and clinical impact

Orrù, Emanuele; Sorte, Danielle Eckart; Gregg, Lydia; Wolinsky, Jean Paul; Jallo, George I.; Bydon, Ali; Tamargo, Rafael J.; Gailloud, Philippe

doi:10.1136/neurintsurg-2016-012467

Cited by 19 publications

(14 citation statements)

References 25 publications

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“…9 They acknowledged that the popliteal artery provides an easy access for intraoperative DSA in the prone position with a low risk of complications to confirm obliteration of the vascular malformation. 9 Moreover, Villelli et al, 9 Orru' et al, 10 and Hayashi et al 21 described intraoperative DSA with a mobile C-arm after catheterization of the femoral, popliteal, or brachial artery.…”

Section: Discussionmentioning

confidence: 99%

“…1,8 Intraoperative digital subtraction angiography (DSA) to confirm occlusion of SDAVF has been recently reported using a portable fluoroscopic C-arm in the operating room. 9,10 We describe four patients with progressive leg weakness who underwent surgical obliteration of SDAVF with spinal intraoperative DSA in the prone position after cannulation of the popliteal artery within the hybrid operating room (OR).…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

Kienzler

Schoepf

Marbacher

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Spinal dural arteriovenous fistula (SDAVF) is a rare cause of progressive myelopathy in predominantly middle-aged men. Treatment modalities include surgical obliteration and endovascular embolization. In surgically treated cases, failure of obliteration is reported in up to 5%. The aim of this technical note is to present a safe procedure with complete SDAVF occlusion, verified by intraoperative digital subtraction angiography (DSA). Methods We describe four patients with progressive leg weakness who underwent surgical obliteration of SDAVF with spinal intraoperative DSA in the prone position after cannulation of the popliteal artery. All surgeries took place in our hybrid operating room (OR) and were accompanied by electrophysiologic monitoring. Surgeries and cannulation of the popliteal artery were performed in the prone position. Ultrasound was used to guide the popliteal artery puncture. A 5-Fr sheath was inserted and the fistula was displayed using a 5-Fr spinal catheter. Spinal intraoperative DSA was performed prior to and after temporary clipping of the fistula point as well after the final SDAVF occlusion. Results The main feeder of the SDAVF fistula in the first patient arose from the right T11 segmental artery, which also supplied the artery of Adamkiewicz. The second patient initially underwent endovascular treatment and deteriorated 5 months later due to recanalization of the SDAVF via a small branch of the T12 segmental artery. The third and fourth cases were primarily scheduled for surgical occlusion. Access through the popliteal artery for spinal intraoperative DSA proved to be beneficial and safe in the hybrid OR setting, allowing the sheath to be left in place during the procedure. During exposure and after temporary and permanent occlusion of the fistulous point, intraoperative indocyanine green (ICG) video angiography was also performed. In one case, the addition of intraoperative DSA showed failure of fistula occlusion, which was not visible with ICG angiography, leading to repositioning of the clip. Complete fistula occlusion was documented in all cases. Conclusion Spinal intraoperative DSA in the prone position is a feasible and safe intervention for rapid localization and confirmation of surgical SDAVF occlusion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

Kienzler

Schoepf

Marbacher

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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“…described a technique of obtaining femoral access while the patient was in the supine position. 13 Once the sheath was secured to the lateral thigh, the patient was then flipped prone for the spine surgery. 13 The catheter was then accessed on the lateral thigh when intraoperative angiography was needed.…”

Section: Discussionmentioning

confidence: 99%

“…13 Once the sheath was secured to the lateral thigh, the patient was then flipped prone for the spine surgery. 13 The catheter was then accessed on the lateral thigh when intraoperative angiography was needed. 13 Although this is feasible, issues with sheath thrombosis or kinking can arise.…”

Section: Discussionmentioning

confidence: 99%

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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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Diagnostische Neuroradiologie

Dörfler¹,

Forsting²

2017

Klinische Neurologie

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Intraoperative spinal digital subtraction angiography: indications, technique, safety, and clinical impact

Cited by 19 publications

References 25 publications

Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

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

Diagnostische Neuroradiologie

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