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Intra-Arterial Intraoperative CT Angiography Guided Navigation: A New Technique for Localization of Vascular Pathology.
MedLine Citation:
PMID:  22858682     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Precise intraoperative surgical localization of small distal aneurysms, arteriovenous malformations, and skull 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 in size. We introduce the technique of intraoperative CT 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 includes 8 patients: two patients with aneurysms, three with small cortical AVMs, and three with skull base DAVFs. An intraoperative computed tomography angiography with intra-arterial contrast injection was obtained for 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 DAVFs. 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.
Shaan M Raza; Kyriakos Papadimitriou; Dheeraj Gandhi; Martin Radvany; Alessandro Olivi; Judy Huang
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-31
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-8-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Departments of Neurosurgery and **Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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