| Intraoperative angiography during microsurgical removal of arteriovenous malformations in children. | |
| | |
MedLine Citation:
|
PMID: 21039166 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECT: Confirming the successful management of pediatric arteriovenous malformations (AVMs) requires high-quality postoperative digital subtraction angiography. Although the role of intraoperative angiography during the microsurgical removal of AVMs is well established in adults, the technique has several limitations including poor image quality, uniplanar image acquisition, and absent full heparin protection. Here, the authors report on their experience with high-quality intraoperative angiography during the surgical management of pediatric AVMs in their image-guided therapy (IGT) facility. METHODS: The authors retrospectively reviewed the demographic, clinical, and radiological characteristics of 22 patients who underwent the surgical management of AVMs at the Hospital for Sick Children in Toronto, with the aid of high-quality intraoperative or immediate postresection cerebral angiography via a transfemoral approach. RESULTS: Between January 2000 and August 2009, 18 children (mean age 13.05 ± 4.04 years, range 4-21 years) underwent both surgical management of an AVM and intraoperative cerebral angiography at an IGT facility. An additional 4 children underwent angiography immediately after surgery in the regular operating room while under the same anesthesia. The mean AVM size was 2.55 ± 1.43 cm (range 1-6 cm) with a mean Spetzler-Martin grade of 2.27 (range 1-4). Intraoperative angiography in 4 of the 18 patients demonstrated residual AVM requiring additional resection. One patient demonstrated residual AVM on immediate postoperative angiography and underwent immediate reoperation. Successful excision of the residual AVM was confirmed on angiography the following day in that case. Procedural complications occurred in connection with 1 (3.3%) of 30 angiograms, including asymptomatic transient nonfilling of an ophthalmic artery, which was resolved on follow-up angiography. Negative intraoperative angiograms were confirmed with follow-up angiograms in 15 (93.75%) of 16 patients at a mean of 9.93 ± 5.70 months. One patient with a negative intraoperative angiogram demonstrated a tiny residual AVM on follow-up angiography at 8 months (false-negative rate 6.25%), but had a negative preoperative angiogram 1 year later in the IGT facility. No patient with a negative intraoperative angiogram required further AVM-directed treatment. CONCLUSIONS: Intraoperative angiography is a safe and effective adjunct to the surgical management of AVMs in children. This novel approach allows the pre-, intra-, and postoperative acquisition of high-quality images, which can help guide the resection of AVMs, especially those that are small, diffuse, or of a complex angioarchitecture. |
| | |
Authors:
|
Michael J Ellis; Abhaya V Kulkarni; James M Drake; James T Rutka; Derek Armstrong; Peter B Dirks |
Related Documents
:
|
9607536 - Ruptured hepatocellular carcinoma as a complication of transarterial oily chemoemboliza... 20190666 - A supplementary grading scale for selecting patients with brain arteriovenous malformat... 18813936 - Endoscopic third ventriculostomy: the best option in the treatment of persistent hydroc... 17047356 - Pre-operative endovascular embolization of a cerebellar haemangioblastoma. a case report. 15094976 - Laparoscopy for malignancy: current status. 9704826 - Chronic neuropathic symptoms after exposure to mustard gas: a long-term investigation. |
Publication Detail:
|
Type: Case Reports; Journal Article |
Journal Detail:
|
Title: Journal of neurosurgery. Pediatrics Volume: 6 ISSN: 1933-0715 ISO Abbreviation: J Neurosurg Pediatr Publication Date: 2010 Nov |
Date Detail:
|
Created Date: 2010-11-02 Completed Date: 2010-11-29 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 101463759 Medline TA: J Neurosurg Pediatr Country: United States |
Other Details:
|
Languages: eng Pagination: 435-43 Citation Subset: IM |
Affiliation:
|
Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Angiography, Digital Subtraction* / instrumentation Cerebral Angiography* / instrumentation Child Child, Preschool False Negative Reactions Female Humans Intracranial Arteriovenous Malformations / radiography*, surgery* Intraoperative Care* / instrumentation Male Microsurgery* / instrumentation Operating Rooms Postoperative Complications / radiography Retrospective Studies Surgical Equipment Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Gamma Knife surgery for arteriovenous malformations in children.
Next Document: Evolution of treatment options for vein of Galen malformations.