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Erdogan K, Mammadkhanli O, Abbasoglu B, Bayatli E, Ozden M, Bozkurt M. Evaluation of the Utility of Indocyanine Green Video Angiography in Cerebral Arteriovenous Malformation Surgery. World Neurosurg 2023; 170:e603-e611. [PMID: 36436772 DOI: 10.1016/j.wneu.2022.11.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the utility of intraoperative indocyanine green video angiography (ICG-VA) during microsurgical resection of arteriovenous malformations (AVMs). METHODS Data of the 24 patients, who were surgically treated for AVM using intraoperative ICG-VA, were reviewed retrospectively. Postoperative digital subtraction angiography (DSA) was performed in all patients before they regained consciousness and became fully awake, and the results were compared with those obtained with intraoperative ICG-VA. A scheduled DSA was performed in all patients in the third, sixth, and 12th postoperative months as well. RESULTS Authors retrospectively analyzed the records of intraoperative ICG-VA application of all 24 patients. Though the exposures were limited and the image qualities were poor at higher magnification on the surgical microscope within deep surgical fields, the AVM niduses, feeding arteries, draining veins, and their relations to normal vasculature were observed precisely with ICG-VA in all the procedures. Furthermore, the visualization was not qualified enough to identify these pathological vascular structures accurately before evacuating and irrigating the layer of blood clots that obscure the view in patients who presented with hemorrhage. In a patient in our series, a residual nidus in the tail of the caudate nucleus was detected with immediate postoperative DSA which was not revealed by terminal assessment with final intraoperative ICG-VA. CONCLUSIONS Intraoperative ICG-VA is particularly effective in the identification of the feeder, nidus, and drainer and in the assessment of the flow dynamics of the nidus in cerebral AVM surgery. It may be a quick and safe technique for intraoperative imaging of the angioarchitecture of superficial AVMs, but it may be less helpful for deep-seated lesions. Furthermore, this method alone may not be useful in the identification of residual disease or improvement of the clinical outcomes. DSA has remained the gold standard for confirming AVM obliteration. Despite the technical limitations associated with ICG-VA, a combination of intraoperative ICG-VA and immediate postoperative DSA may advance the safety and efficacy of AVM surgery.
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Affiliation(s)
- Koral Erdogan
- Department of Neurosurgery, Ankara University School of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
| | - Orkhan Mammadkhanli
- Department of Neurosurgery, Trakya University School of Medicine, Edirne, Turkey
| | - Bilal Abbasoglu
- Department of Neurosurgery, Ankara University School of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
| | - Eyup Bayatli
- Department of Neurosurgery, Ankara University School of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
| | - Mahmut Ozden
- Department of Neurosurgery, Arel University, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Melih Bozkurt
- Department of Neurosurgery, Arel University, Memorial Bahcelievler Hospital, Istanbul, Turkey.
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Izumo T, Yoshida M, Okamura K, Takahira R, Sadakata E, Yamaguchi S, Baba S, Morofuji Y, Hiu T, Anda T, Matsuo T. Pseudo-residual nidus after arteriovenous malformation surgery: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022. [PMCID: PMC9379732 DOI: 10.3171/case2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intraoperative indocyanine green video angiography (ICG-VA) is useful for determining the extent of lesion removal during cerebral arteriovenous malformation (AVM) surgery. The authors described a case of surgical removal of an AVM presenting with early venous filling mimicking a residual nidus on intraoperative ICG-VA. OBSERVATIONS A 7-year-old girl experienced a sudden disturbance of consciousness. Computed tomography revealed right frontal intracerebral hemorrhage. Digital subtraction angiography showed a Spetzler-Martin grade 1 AVM in the right frontal lobe. The patient received surgical removal of the AVM after endovascular embolization. After removal of the nidus, the first intraoperative ICG-VA revealed early venous filling of the cortex around the excision cavity. Additional resection of the cortex around this area was performed. Histopathological examination of the lesion revealed a dilated normal vascular structure without an AVM. LESSONS Early venous filling in the surrounding brain tissue after AVM removal does not necessarily indicate a residual nidus. The need for additional resection of the lesion depends on the eloquence of the area.
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Affiliation(s)
- Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Michiharu Yoshida
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuaki Okamura
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryotaro Takahira
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Eisaku Sadakata
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Yamaguchi
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shiro Baba
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Hiu
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeo Anda
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Tao S, Zhang T, Zhou K, Liu X, Feng Y, Zhao W, Chen J. Intraoperative Monitoring Cerebral Blood Flow During the Treatment of Brain Arteriovenous Malformations in Hybrid Operating Room by Laser Speckle Contrast Imaging. Front Surg 2022; 9:855397. [PMID: 35599788 PMCID: PMC9120635 DOI: 10.3389/fsurg.2022.855397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hemodynamic changes caused by hybrid surgery for brain arteriovenous malformations (bAVM) are usually related to long-term lesions from "blood stealing". There are currently no viable low-cost, noninvasive procedures for assessing cerebral perfusion in the operating room. This study aims to investigate the use of intraoperative laser speckle contrast image (LSCI) software in AVM surgery. Methods In Zhongnan Hospital of Wuhan University, 14 patients who underwent surgery with LSCI were collected. To analyze the hemodynamic features of AVM and the influence on the peripheral cortex of AVM embolization and resection, we assessed the transit time between feeding arteries and drainage veins by intraoperative digital subtraction angiography (DSA). Meanwhile, LSCI was performed at pre-embolization, post-embolization, and after complete resection of bAVM. Results In this study, the transit time of bAVM before and after embolization was compared, the transit time before embolization was significantly shorter than that after embolization (p < 0.05). We also got good visualization of relative CBF, in addition, to flow imaging in the cortical vasculature round bAVM with LSCI. The flux of post-surgery was significantly higher than pre-embolization (p < 0.01). Conclusion Hemodynamic variable assessment plays an important role in the resection of AVM in the hybrid operative room and LSCI can be used to visualize and evaluate cortical cerebral blood flow to detect pathological hyperperfusion in real-time with a good spatial-temporal resolution in a sensitive and continuous, non-invasive mode.
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Affiliation(s)
- Sicai Tao
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Tingbao Zhang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Keyao Zhou
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Xiaohu Liu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Feng
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Wenyuan Zhao
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
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Klironomos G, Chiluwal AK, Dehdashti AR. Technical Note: Extreme Lateral Supracerebellar Approach for Resection of Superior Cerebellar Peduncle Arteriovenous Malformations. Oper Neurosurg (Hagerstown) 2021; 20:E334-E339. [PMID: 33484142 DOI: 10.1093/ons/opaa472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The surgical approaches to the region of the cerebello-mesencephalic sulcus and superior cerebellar peduncle (SCP) remain a neurosurgical challenge. OBJECTIVE To present the use of the extreme lateral supracerebellar infratentorial (SC-IT) approach to treat arteriovenous malformations (AVMs) of the SCP, which is a different entity compared to brainstem AVMs. METHODS We treated 4 patients with SCP AVMs in the last 5 yr at our institution. The mean age was 49.7 yr. The average nidus size was 2.12 cm. Of those, 3 patients presented with hemorrhage and 1 with headache and tinnitus. Extreme lateral SC-IT approach was used in all cases. RESULTS Complete resection was achieved in all cases as verified with postoperative angiogram. In 1 case, intraoperative rupture with intraventricular hemorrhage was encountered, and the patient required temporary external ventricular drainage. There was no permanent complication or neurological deficit. The modified Rankin Scale (at discharge or follow-up) was less than 2 in all cases. CONCLUSION The AVMs located primarily in the SCP are distinct compared to brainstem AVMs, and their management should be different. Extreme lateral SC-IT approach should be considered as a viable alternative surgical approach for resection of these AVMs, and excellent surgical results can be achieved.
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Affiliation(s)
- Georgios Klironomos
- Department of Neurosurgery, South Shore University Hospital, Northwell Health, Bay Shore, New York
| | - Amrit K Chiluwal
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Amir R Dehdashti
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York
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Complications in AVM Surgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 132:77-81. [PMID: 33973032 DOI: 10.1007/978-3-030-63453-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In AVM surgery perioperative complications can arise and can have serious perioperative consequences. Surgically related complications in AVM treatment, in many cases, can be avoided by paying attention to details:1. Careful selection of the patient: - addressing a patient with eloquent AVM to Gamma Knife treatment - preoperative treatment with selective embolization of the accessible deep feeders - preoperative gamma knife or embolize those patient with an over-expressed venous pattern2. Meticulous coagulation of deep medullary feeders: - Using dirty coagulation - Using dry non-stick coagulation - Using micro clips - Using laser - Reaching the choroidal vessel in the ventricle when possible - Avoiding occlusive coagulation with hemostatic agents3. Check and avoiding any residual of the AVM4. Keep the patient under pressure control during postoperative periodFulfilling these steps contributes to reduce complications in this difficult surgery, leading to a safer treatment that compares favorably with natural history of brain arteriovenous malformations.
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Ye X, Wang L, Li MT, Chen XL, Wang H, Ma L, Wang R, Zhang Y, Cao Y, Zhao YL, Zhang D, Wang S. Hemodynamic changes in superficial arteriovenous malformation surgery measured by intraoperative ICG fluorescence videoangiography with FLOW 800 software. Chin Neurosurg J 2020; 6:29. [PMID: 32922958 PMCID: PMC7416385 DOI: 10.1186/s41016-020-00208-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background Arteriovenous malformation(AVM) have long-term "blood stealing" characteristics, which result in complicated hemodynamic features. To analyze the application of intraoperative indocyanine green angiography with FLOW 800 software in AVM surgeries. Methods Data on 17 patients undergoing surgery with ICG fluorescence were collected in Beijing Tiantan Hospital. To analyze the hemodynamic features of AVM and the influence on the peripheral cortex of AVM resection, we assessed the following hemodynamic parameters: maximum intensity, slope of rise, time to half-maximal fluorescence, and transit time from arteries to veins. Results In the 17 superficial AVMs studied, the time-delay color mode of the FLOW 800 software was superior to the traditional playback mode for identifying feeding arteries, draining veins, and their relation to normal cortical vessels. The maximum fluorescence intensity and slope of the ICG fluorescence curve of feeder arteries and draining veins were higher than those of normal peripheral vessels (P < 0.05). The transit times in AVMs were significantly shorter than those in normal peripheral vessels (P < 0.05). After AVM resection, cerebral flow increased in the cortex, and local cycle time becomes longer, although the differences were not significant (P > 0.05). Conclusions Hemodynamic parameter analysis provided quality guidance for the resection of AVMs and could also be used in estimating changes in blood flow in the local cortex to identify abnormal hyperperfusion and residual nidus.
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Affiliation(s)
- Xun Ye
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Liang Wang
- Department of Neurosurgery, Tianjin Fifth Center Hospital, Tianjin, 300450 China.,Department of Neurosurgery, Peking University International Hospital, Beijing, 102206 China
| | - Ming-Tao Li
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Xiao-Lin Chen
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Hao Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Li Ma
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Yuan-Li Zhao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100050 China
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Sasaki K, Endo H, Niizuma K, Nishijima Y, Osawa S, Fujimura M, Tominaga T. Efficacy of intra-arterial indocyanine green angiography for the microsurgical treatment of dural arteriovenous fistula: A case report. Surg Neurol Int 2020; 11:46. [PMID: 32257572 PMCID: PMC7110105 DOI: 10.25259/sni_588_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background In this study, we report a case of dural arteriovenous fistula (dAVF) that was successfully treated using intra-arterial indocyanine green (IA-ICG) videoangiography during open surgery. Moreover, the findings of IA-ICG videoangiography were compared with those of intraoperative digital subtraction angiography (DSA). Case Description A 72-year-old male patient with a history of hypertension, hyperlipidemia, and thrombocytosis presented with generalized seizure. DSA revealed Cognard Type III dAVF in the superior wall of the left transverse sinus, which was fed by a single artery (the left occipital artery [OA]) and drained into a single vein (the left temporal cortical vein), without drainage into a venous sinus. Since transarterial embolization was considered challenging due to the tortuosity of the left OA, surgical interruption of the shunt was performed by craniotomy. After excising the feeding artery, we were unable to observed dAVF on intraoperative DSA. However, IA-ICG videoangiography revealed the remaining shunt, which was fed by the collateral route from the feeding artery. The shunting point and draining vein were then surgically resected to eliminate the shunt. The shunt was not observed during the second IA-ICG videoangiography conducted after resection. Conclusion ICG videoangiography is a better method compared with DSA in terms of visualizing fine vascular lesions. In contrast to the typical intravenous administration, selective IA-ICG can be repeatedly injected at a minimal dose. IA-ICG is a useful intraoperative tool that can be used to evaluate the elimination of the dAVF.
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Affiliation(s)
- Keisuke Sasaki
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
| | - Hidenori Endo
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
| | - Kuniyasu Niizuma
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Japan.,Departments of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Medicine, Tohoku University, Japan
| | - Yasuo Nishijima
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
| | - Shinichiro Osawa
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Teiji Tominaga
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
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Akbayrak H, Çiçek ÖF, Orhan A, Büyükateş M. The Advantages of Using Intraoperative Indocyanine Green Fluorescence Angiography for Upper Extremity Arteriovenous Malformation: A Case Report. Ann Vasc Surg 2019; 59:306.e7-306.e10. [DOI: 10.1016/j.avsg.2019.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 12/01/2022]
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Choi E, Lee JY, Jeon HJ, Cho BM, Yoon DY. A hybrid operating room for combined surgical and endovascular procedures for cerebrovascular diseases: a clinical experience at a single centre. Br J Neurosurg 2019; 33:490-494. [PMID: 31092005 DOI: 10.1080/02688697.2019.1617403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). Material and methods: A single-plane DSA system with 3-dimensional rotational angiography (3DRA), cone-beam computed tomography, and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of neurovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorised into five subcategorical procedures according to the dominance of surgical and/or endovascular procedures: intraoperative angiographic evaluation, combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, surgical approach for interventional procedure, and frameless stereotaxic operation. Results: Intraoperative angiography revealed unsatisfactory clipping of intracranial aneurysms in 6 (13.6%) patients and remnant AVMs in 1 (16.7%) patient, which were determined as complete surgical outcome via indocyanine green videoangiography. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial haemorrhage (ICH) were treated by partial embolisation and surgical clipping. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolisation. In 1 (0.8%) complicated case of 103 intra-arterial (IA) thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. Direct puncture of the common carotid artery or vertebral artery was performed to achieve interventional access to treat aneurysm or recanalise vessel occlusions in 7 cases. In 27 cases of ICH, frameless stereotaxic haematoma aspiration was performed using XperGuide® system. All procedures were performed in single sessions without any procedural complications. Conclusion: Hybrid OR with a fully equipped DSA system could provide safe and precise treatment for neurovascular diseases. Hybrid procedures for neurovascular diseases in hybrid OR are a promising new trend.
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Affiliation(s)
- Euidon Choi
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Jong Young Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Hong Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Byung-Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
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Hayashi N, Tomura N, Okada H, Sasaki T, Tsuji E, Enomoto H, Kuwata T. Usefulness of preoperative cone beam computed tomography and intraoperative digital subtraction angiography for dural arteriovenous fistula at craniocervical junction: Technical case report. Surg Neurol Int 2019; 10:5. [PMID: 30775059 PMCID: PMC6357538 DOI: 10.4103/sni.sni_439_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/03/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Direct surgery is commonly selected for the treatment of cranio-cervical junction dural arteriovenous fistula and its outcome is more satisfactory than that of embolization. Intraoperative treatment evaluation is relatively easy in embolization, whereas in direct surgery it can be difficult. Case Description: A 67-year-old male suffered a subarachnoid hemorrhage. On three-dimensional (3D) images of preoperational cone-beam computed tomography (CBCT), the structure of the draining vein was depicted in detail along with the surrounding bone structures. The radial artery penetrated the dura mater, and it was found that there were two veins derived from the radiculospinal vein; one was the anterior radicular vein descending toward the dorsal side (the shallow layer of the surgical field) and the other was the anterior spinal medullary vein ascending toward the ventral side (the deep layer of the surgical field) and flowing out to the anterior spinal vein. Conclusion: Without detailed assessments with preoperative CBCT, the surgery might have been done with dissection of only the anterior radicular vein in the shallow layers. For identification of the draining vein located deep in the surgical field, such as the cranio-cervical junction, careful assessments using 3D CBCT images are important.
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Affiliation(s)
- Nobuhide Hayashi
- Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan
| | - Nagatsuki Tomura
- Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan
| | - Hideo Okada
- Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan
| | - Takahiro Sasaki
- Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan
| | - Eisaku Tsuji
- Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan
| | - Hiroki Enomoto
- Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan
| | - Toshikazu Kuwata
- Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan
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Bretonnier M, Henaux PL, Morandi X, Le Reste PJ. Fluorescein-guided resection of brain arteriovenous malformations: A short series. J Clin Neurosci 2018; 52:37-40. [DOI: 10.1016/j.jocn.2018.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/09/2018] [Accepted: 02/04/2018] [Indexed: 10/17/2022]
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Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, Torner JC. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2017. [DOI: 10.1161/str.0000000000000134] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Neurovascular surgery is a broad and challenging, yet exciting field within neurologic surgery. The neurovascular surgeon must be meticulous; because the brain and spinal cord are unforgiving to ischemic insults. Along with the pressures of this demanding subspecialty comes the potential to help patients recover from potentially devastating pathology to go on and lead normal, healthy lives. Several intraoperative imaging modalities are available to help maximize treatment success while reducing risk. This article reviews each of these modalities, including digital subtraction angiography, fluorescence angiography, Doppler ultrasonography, laser Doppler, laser speckle contrast imaging, neuronavigation, and neuroendoscopy.
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