Intra-arterial intraoperative computed tomography angiography guided navigation

A new technique for localization of vascular pathology

Shaan M. Raza, Kyriakos Papadimitriou, Dheeraj Gandhi, Martin Radvany, Alessandro Olivi, Judy Huang

Research output: Contribution to journalArticle

Abstract

BACKGROUND:: Precise intraoperative surgical localization of small distal aneurysms, arteriovenous malformations (AVMs), and cranial base dural arteriovenous fistulae may be challenging. Current neuronavigational techniques are based on imaging techniques with limited sensitivity to detect vascular lesions that are small. We introduce the technique of intraoperative computed tomography angiography (iCTA) with an intra-arterial injection for surgical navigation. OBJECTIVE:: To determine whether iCTA integrated with a navigation platform is accurate and useful for precise localization of small vascular lesions that are challenging to treat. METHODS:: This study included 8 patients: 2 with aneurysms, 3 with small cortical AVMs, and 3 with cranial base dural arteriovenous fistulae. iCTA with intra-arterial contrast injection was performed in all patients for precise localization of the small vascular lesion to facilitate craniotomy planning and microsurgical approach. All operative reports, inpatient and outpatient records, and radiographic studies available were reviewed retrospectively. RESULTS:: The iCTA was used to target 2 aneurysms, 3 small subcortical AVMs, and 3 dural arteriovenous fistulae. This technique was most helpful to localize the 3 AVMs and the distal M4 aneurysm precisely. Craniotomy planning was accurate in all instances; no complications related to the technique were noted, and all patients had uneventful postoperative recoveries. CONCLUSION:: iCTA is an effective and accurate novel technique that can enhance the safety of surgical treatment for small intra-axial vascular pathology.

Original languageEnglish (US)
JournalNeurosurgery
Volume71
Issue numberSUPPL.2
DOIs
StatePublished - Dec 2012

Fingerprint

Arteriovenous Malformations
Blood Vessels
Central Nervous System Vascular Malformations
Aneurysm
Pathology
Intra-Arterial Injections
Craniotomy
Skull Base
Inpatients
Outpatients
Computed Tomography Angiography
Safety
Therapeutics

Keywords

  • Arteriovenous malformation
  • Cerebral aneurysm
  • Computed tomography angiography
  • Dural arteriovenous fistula
  • Intraoperative imaging

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Intra-arterial intraoperative computed tomography angiography guided navigation : A new technique for localization of vascular pathology. / Raza, Shaan M.; Papadimitriou, Kyriakos; Gandhi, Dheeraj; Radvany, Martin; Olivi, Alessandro; Huang, Judy.

In: Neurosurgery, Vol. 71, No. SUPPL.2, 12.2012.

Research output: Contribution to journalArticle

Raza, Shaan M. ; Papadimitriou, Kyriakos ; Gandhi, Dheeraj ; Radvany, Martin ; Olivi, Alessandro ; Huang, Judy. / Intra-arterial intraoperative computed tomography angiography guided navigation : A new technique for localization of vascular pathology. In: Neurosurgery. 2012 ; Vol. 71, No. SUPPL.2.
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N2 - BACKGROUND:: Precise intraoperative surgical localization of small distal aneurysms, arteriovenous malformations (AVMs), and cranial base dural arteriovenous fistulae may be challenging. Current neuronavigational techniques are based on imaging techniques with limited sensitivity to detect vascular lesions that are small. We introduce the technique of intraoperative computed tomography angiography (iCTA) with an intra-arterial injection for surgical navigation. OBJECTIVE:: To determine whether iCTA integrated with a navigation platform is accurate and useful for precise localization of small vascular lesions that are challenging to treat. METHODS:: This study included 8 patients: 2 with aneurysms, 3 with small cortical AVMs, and 3 with cranial base dural arteriovenous fistulae. iCTA with intra-arterial contrast injection was performed in all patients for precise localization of the small vascular lesion to facilitate craniotomy planning and microsurgical approach. All operative reports, inpatient and outpatient records, and radiographic studies available were reviewed retrospectively. RESULTS:: The iCTA was used to target 2 aneurysms, 3 small subcortical AVMs, and 3 dural arteriovenous fistulae. This technique was most helpful to localize the 3 AVMs and the distal M4 aneurysm precisely. Craniotomy planning was accurate in all instances; no complications related to the technique were noted, and all patients had uneventful postoperative recoveries. CONCLUSION:: iCTA is an effective and accurate novel technique that can enhance the safety of surgical treatment for small intra-axial vascular pathology.

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