Simple technique for intraoperative angiographic localization of small vascular lesions

Neurosurgery
Anand V GermanwalaRafael J Tamargo

Abstract

Precise surgical localization of small arteriovenous malformations (AVMs), arteriovenous fistulae (AVFs), and aneurysms located in the distal portions of the intracranial arteries can be difficult. We describe a simple and accurate intraoperative angiographic localization technique for small AVMs, AVFs, and distal aneurysms. All patients had routine preoperative diagnostic imaging and evaluations, including catheter angiography. Once anesthetized, the patients were prepared for intraoperative angiography following cannulation of the femoral artery. Craniometric landmarks were utilized to approximately localize the lesion. A wire in the shape of a square was placed over the proposed craniotomy site and an angiogram was performed. With use of real-time angiography, the wire localizer was manipulated until the small vascular lesion was visualized entirely within the wire frame, thus defining the extent of the required craniotomy and the surgical trajectory. The wire localizer was used to target small vascular lesions in 9 cases of AVMs, 4 cases of distal middle cerebral artery aneurysms, and 1 case of a diploic AVF. In all 14 cases, the lesion was accurately localized intraoperatively without further image-guided techniques, and t...Continue Reading

References

Jul 1, 1991·Journal of Neurosurgery·M B SistiB M Stein
Apr 1, 1982·Surgical Neurology·P J KelleyJ G Zoll
Jun 18, 2002·Journal of Neurosurgery·Veronica L ChiangRafael J Tamargo
Nov 25, 2003·Minimally Invasive Neurosurgery : MIN·R Schmid-ElsaesserH-J Steiger
Sep 12, 2006·Journal of Neurosurgery·Andreas RaabeVolker Seifert

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Citations

Nov 24, 2011·Neurosurgery Clinics of North America·Gustavo PradillaRafael J Tamargo
Nov 24, 2011·Neurosurgery Clinics of North America·Geoffrey P ColbyRafael J Tamargo
Jul 8, 2014·Neurologia Medico-chirurgica·Yasuo MuraiAkira Teramoto

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