Abstract
This study aimed to explore the clinical applications of multimodal navigation combined with indocyanine green (ICG) fluorescein angiography in microsurgical treatment of cerebral arteriovenous malformations (AVMs). We retrospectively collected 52 patients with AVMs. Assisted by anatomic image, we reestablished three-dimensional structure using preoperative functional magnetic resonance imaging (fMRI) and Diffusion tensor imaging (DTI). The operation for lesion resection was finished under the assistance of neuro-navigation. ICG fluorescein angiography was performed for 16 of the study subjects, meanwhile, FLOW800 was used to rebuild blood vessel color visual image. Brain angiography was performed 1 week after the operation to check residual malformations. The patients’ status was estimated by Modified Rankin Scale score. Of the AVMs, 92.3% (48/52) were totally removed, without severe side events. Among the patients, fluorescein angiography was carried out up to 58 times for 16 cases. All of these 16 cases were confirmed with malformations and 14 of them had draining vein. The total resection rate of these 16 cases reached 100%, and the occurrence rate of postoperative complications was not significantly increased. During the operation of lesion resection, the application of multimodal navigation could effectively protect functional cortex and conduction pathway.
Highlights
Characteristic Size 6 cm Pattern of venous drainage superficial deep both Location eloquent site non-eloquent site Spetzler-Martin grade I II III IV
The function cortex and function tracts were identified in intra-operative navigation.Total resection was achieved in 20 of the 24 cases implicating functional areas, who kept intact function; as for the other 4 patients, their arteriovenous malformations were found to have close ties to the function areas where residues existed
Several treatments have been developed for treating arteriovenous malformations, like microsurgical resection, endovascular embolization and radiotherapy
Summary
Characteristic Size 6 cm Pattern of venous drainage superficial deep both Location eloquent site non-eloquent site Spetzler-Martin grade I II III IV. There were 9 subtentorial cerebel and brain stem AVMs, and 65 supratentorial cerebral AVMs. Among the 65 cases with supratentorial cerebral AVMs, 13 with cerebral hernia resulting from cerebral AVM rupture bleeding received emergency operation while the other 52 were treated with multimodal navigation. Among the 65 cases with supratentorial cerebral AVMs, 13 with cerebral hernia resulting from cerebral AVM rupture bleeding received emergency operation while the other 52 were treated with multimodal navigation These 52 patients were selected as our study subjects, containing 35 males and 17 females with an average age of 34.5 (ranging from 4~62 years old), 4 cases under 16 years old. According to the results of fMRI, DTI and preoperative preparation, three-dimensional structure was reestablished to demonstrate the location and morphology of lesions, vascular status, functional region and conduction bundle (Fig. 1, 2). As for patients with epilepsy, cortical electrode was adopted during the operation to locate epileptogenic focus
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