Intraoperative angiography reloaded: a new hybrid operating theater for combined endovascular and surgical treatment of cerebral arteriovenous malformations: a pilot study on 25 patients
Intraoperative angiography reloaded: a new hybrid operating theater for combined endovascular and surgical treatment of cerebral arteriovenous malformations: a pilot study on 25 patients
复制标题
DOI：
10.1007/s00701-013-1873-z
复制
发表时间：
2013-11-01
影响因子：
2.4
通讯作者：
Schaller, Karl
中科院分区：
文献类型：
--
作者：
Kotowski, Marc;Sarrafzadeh, Asita;Schaller, Karl
脑动静脉畸形（AVM）患者的多模态治疗套件最近已上市。本研究旨在评价一种新的基于术中平板（FP）的集成手术和成像套件用于脑AVM的血管内和手术联合治疗的可行性、安全性和对治疗的影响。本连续病例系列前瞻性入组了25例接受血管内和手术联合治疗的AVM患者。该混合套件允许使用术中扫描仪样成像（XperCTA（R））和术中3D旋转血管造影（3D-RA）进行血管内和手术方法的组合。分析了术中多模式成像对可行性、联合干预工作流程、手术和非预期成像结果的影响。25例中位Spetzler-Martin 2级AVM（范围1-4）患者（平均年龄38 ± 18.6岁）接受了联合血管内和外科手术。16名患者出现破裂AVM，9名患者出现未破裂AVM。在16%（n = 4）的病例中，术中成像显示AVM残留物为千分之一货币符号3 mm，并允许在同一手术中完成切除。到目前为止，在所有n = 16例术后1年随访血管造影的患者中证实了完全切除。所有的诊断和治疗步骤，包括血管造影控制，无需移动病人的混合神经介入套件被证明是一个安全和有用的设置，允许不受约束的组合显微外科和神经放射学的工作流程。它减少了对术中血管造影控制和随后可能的第二次手术翻修的需求，因为可以高度安全地检测到小AVM残留物。
Multimodality treatment suites for patients with cerebral arteriovenous malformations (AVM) have recently become available. This study was designed to evaluate feasibility, safety and impact on treatment of a new intraoperative flat-panel (FP) based integrated surgical and imaging suite for combined endovascular and surgical treatment of cerebral AVM.Twenty-five patients with AVMs to treat with combined endovascular and surgical interventions were prospectively enrolled in this consecutive case series. The hybrid suite allows combined endovascular and surgical approaches with intraoperative scanner-like imaging (XperCTA (R)) and intraoperative 3D rotational angiography (3D-RA). The impact of intraoperative multimodal imaging on feasibility, workflow of combined interventions, surgery, and unexpected imaging findings were analyzed.Twenty-five patients (mean age 38 +/- 18.6 year) with a median Spetzler-Martin grade 2 AVM (range 1-4) underwent combined endovascular and surgical procedures. Sixteen patients presented with a ruptured AVM and nine with an unruptured AVM. In 16 % (n = 4) of cases, intraoperative imaging visualized AVM remnants a parts per thousand currency sign3 mm and allowed for completion of the resections in the same sessions. Complete resection was confirmed in all n = 16 patients who had follow-up angiography one year after surgery so far. All diagnostic and therapeutical steps, including angiographic control, were performed without having to move the patientsThe hybrid neurointerventional suite was shown to be a safe and useful setup which allowed for unconstrained combined microsurgical and neuroradiological workflow. It reduces the need for extraoperative angiographic controls and subsequent potential surgical revisions a second time, as small AVM remnants can be detected with high security.