Treatment of complex neurovascular lesions: an interdisciplinary angio suite approach

Abstract

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.

Non-enhanced magnetic resonance imaging of unruptured intracranial aneurysms at 7 Tesla: Comparison with digital subtraction angiography

“…ICA internal carotid artery, TOF time-of-flight, MRA magnetic resonance angiography, DSA digital subtraction angiography, MPRAGE magnetization-prepared rapid acquisition gradient-echo demonstrated to offer three beneficial features: (1) higher SNR (up to four-to fivefold higher than at 1.5 T and up to two-to threefold higher than 3 T) as well as (2) longer T1 relaxation times [32], yielding improved vessel-tissue contrast [33] and (3) inherently hyperintense arterial vasculature [34][35][36]. The third is most likely augmented by the application of local RF transmit coils at 7 T. Body RF coils are commonly applied for signal transmission at lower field strength.…”

Dual Pathologies: Pial Arteriovenous Fistula in Combination with an Arteriovenous Malformation

“…It was not visualized until after resection of the AVM and intraoperative DSA. This scenario thus highlights the advantages of a hybrid operating room 16,17 because the PAVF would otherwise have been gone unnoticed until after postoperative control imaging. Because most of the surgical procedures for both cranial and spinal arteriovenous pathologies are usually not performed in a hybrid room, it could also be well possible that some double arteriovenous pathologies as described in our case are simply not noted so far but nevertheless eradicated due to the residual flow after the occlusion of the first pathology.…”