Optimization of the Surgical Approach in AVMs Using MRI and 4D DSA Fusion Technique

Tritt, Stephanie; Ommer, B.; Gehrisch, Sonja; Klein, Sigrun; Seifert, Volker; Berkefeld, Joachim; Konczalla, Juergen

doi:10.1007/s00062-017-0571-2

Cited by 20 publications

(13 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, they found the LED, determined by fMRI and DTI, to be a single significant predictor of operative risk. Not only did this study report a benefit of modern imaging techniques in bAVM surgery, also DTI of the long association bundles, [3] high-resolution threedimensional multifusion imaging (CT-MRI fusion with combined surface and volume rendering) [46], and MRI fusion with time-resolved (so called 4D) DSA [43] have been reported to be helpful for preoperative planning and intraoperative navigation and eventually to contribute to better surgical outcome.…”

Section: Modern Supratentorial Grading Systemsmentioning

confidence: 76%

Systematic review of brain arteriovenous malformation grading systems evaluating microsurgical treatment recommendation

et al. 2021

View full text Add to dashboard Cite

When evaluating brain arteriovenous malformations (bAVMs) for microsurgical resection, the natural history of bAVM rupture must be balanced against the perioperative risks. It is therefore adamant to have a reliable surgical grading system, balancing these important factors. This study systematically reviews the literature in order to identify and assess the quality of grading systems with regard to microsurgical bAVM treatment. A systematic literature review was performed to provide an overview of all available bAVM grading systems relevant for microsurgical treatment evaluation and to assess the most comprehensive grading system specifically for each subgroup of bAVM (i.e., unruptured, ruptured, and posterior fossa). Screening of 865 papers revealed thirteen grading systems for bAVM microsurgical risk stratification. Among them, two systems were specifically developed for ruptured bAVM and one specifically for posterior fossa bAVM. With one system being fundamentally different for supratentorial bAVM, the remaining nine systems used the same parameters: “size,” “eloquence,” “venous drainage,” “arterial feeders,” “age,” “nidus compactness,” and “hemorrhagic presentation”. This study provides a comprehensive overview of all available bAVM grading systems relevant for surgical risk stratification. Furthermore, in the absence of a universal system appropriate to score all bAVMs, a workflow for selection of the best applicable scoring system in accordance with bAVM subgroups is presented.

show abstract

Section: Modern Supratentorial Grading Systemsmentioning

confidence: 76%

Systematic review of brain arteriovenous malformation grading systems evaluating microsurgical treatment recommendation

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Multimodal imaging fusion at the intracranial level is gaining wider acceptance even though reports remain scarce. 12,[27][28][29] At the aortic arch level, no other reports, to our knowledge, have been published since the pioneering work of Lin et al 15 The VesselNavigator image fusion technique was evaluated in 151 supra-aortic vessels, showing a high spatial accuracy for catheterization at the aortic arch and proximal cervical level. However, we observed that the mismatch increased when reaching distal cervical vessels.…”

Section: Discussionmentioning

confidence: 99%

Fusion Image Guidance for Supra-Aortic Vessel Catheterization in Neurointerventions: A Feasibility Study

Feddal

Escalard

Delvoye

et al. 2020

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Endovascular navigation through tortuous vessels can be complex. Tools that can optimise this access phase need to be developed. Our aim was to evaluate the feasibility of supra-aortic vessel catheterization guidance by means of live fluoroscopy fusion with MR angiography or CT angiography. MATERIALS AND METHODS:Twenty-five patients underwent preinterventional diagnostic MRA, and 8 patients underwent CTA. Fusion guidance was evaluated in 35 sessions of catheterization, targeting a total of 151 supra-aortic vessels. The time for MRA/CTA segmentation and fluoroscopy with MRA/CTA coregistration was recorded. The feasibility of fusion guidance was evaluated by recording the catheterizations executed by interventional neuroradiologists according to a standard technique under fluoroscopy and conventional road-mapping independent of the fusion guidance. Precision of the fusion roadmap was evaluated by measuring (on a semiquantitative 3-point scale) the maximum offset between the position of the guidewires/catheters and the vasculature on the virtual CTA/MRA images. The targeted vessels were divided in 2 groups according to their position from the level of the aortic arch. RESULTS:The average time needed for segmentation and image coregistration was 7 6 2 minutes. The MRA/CTA virtual roadmap overlaid on live fluoroscopy was considered accurate in 84.8% (128/151) of the assessed landmarks, with a higher accuracy for the group of vessels closer to the aortic arch (92.4%; OR, 4.88; 95% CI, 1.83-11.66; P ¼ .003). CONCLUSIONS:Fluoroscopy with MRA/CTA fusion guidance for supra-aortic vessel interventions is feasible. Further improvements of the technique to increase accuracy at the cervical level and further studies are needed for assessing the procedural time savings and decreasing the x-ray radiation exposure.W ith the increasing use of endovascular treatments for cerebrovascular diseases, in an aging population, physicians are more frequently facing complex endovascular navigation. Limitations to the navigation of endovascular devices from the aortic arch to the intracranial vessels still remain, 1,2 and the speed and safety of access through the vascular tortuosity need to be enhanced. 3 Access through tortuous vessels can make the treatment complex and leads to increased procedural time, x-ray exposure, and rate of adverse events or failure. 2,[4][5][6] Routine supra-aortic vessel catheterization in neurovascular procedures uses conventional road-mapping (superimposition of contrast-filled vessels on fluoroscopy using digital subtraction). It

show abstract

“…Comprehensive angioarchitectural information of a cerebral arteriovenous malformation (AVM) can be highly beneficial for risk analysis and treatment planning. 1 Digital subtraction angiography (DSA) remains to be the gold standard for cerebral AVM diagnosis. 2 Conventional clinical assessment typically utilizes a combination of two-dimensional (2D) and three-dimensional (3D) DSA, but rapid vascular filling and vascular overlap in 2D and 3D DSA sometimes compromise the full understand-ing of the cerebral AVM angioarchitecture.…”

Section: Introductionmentioning

confidence: 99%

Four‐dimensional digital subtraction angiography to assess cerebral arteriovenous malformations

Xiang

Yan

Zhao

et al. 2022

Journal of Neuroimaging

View full text Add to dashboard Cite

Background and Purpose The performance of a novel prototype four‐dimensional (4D) digital subtraction angiography (DSA) for cerebral arteriovenous malformation (AVM) diagnosis was evaluated and compared with that of two‐dimensional (2D) and three‐dimensional (3D) DSA. Methods In this retrospective study, 37 consecutive cerebral AVM patients were included. The standard diagnostic results were concluded from the 2D and 3D DSA. Two 4D DSA volumes were reconstructed for each patient by a commercial and a prototype software, then evaluated by two independent experienced neurosurgeons, who were blinded to the diagnosis and treatment process. The evaluation results were compared with the diagnostic results on Spetzler‐Martin (SM) Grading Scale, number of feeding arteries, number of draining veins, and intranidal aneurysms. Results Complete agreement was achieved between 4D DSA and 2D and 3D DSA in SM Grading Scale and intracranial aneurysm identification (agreement coefficient: 1) for both reviewers. The agreement coefficients were .888 and .917 for both reviewers in feeding artery number determination using 4D DSA product and 4D DSA prototype, respectively. The agreement coefficients in draining vein number determination were all larger than .94 for both reviewers using both 4D DSA volumes. Conclusions The performance of this prototype 4D DSA in cerebral AVMs diagnosis was largely equivalent to that of 2D and 3D DSA combination. Four‐dimensional DSA can be regarded as a very good complement for 2D DSA in cerebral AVM diagnosis.

show abstract

Optimization of the Surgical Approach in AVMs Using MRI and 4D DSA Fusion Technique

Cited by 20 publications

References 19 publications

Systematic review of brain arteriovenous malformation grading systems evaluating microsurgical treatment recommendation

Systematic review of brain arteriovenous malformation grading systems evaluating microsurgical treatment recommendation

Fusion Image Guidance for Supra-Aortic Vessel Catheterization in Neurointerventions: A Feasibility Study

Four‐dimensional digital subtraction angiography to assess cerebral arteriovenous malformations

Contact Info

Product

Resources

About