Intraoperative application of a new-generation 3D IV-DSA technology in resection of a hemorrhagic cerebellar AVM.

Burak Ozaydin,Stephanie A Armstrong,Beverly Aagaard-Kienitz,Mustafa K Baskaya,Demi W Dawkins

doi:10.3171/2020.10.focvid2086

Burak Ozaydin, Stephanie A Armstrong + Show 3 more

Open Access

https://doi.org/10.3171/2020.10.focvid2086

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Journal: Neurosurgical focus: Video	Publication Date: Jan 1, 2021
Citations: 1	License type: CC BY 4.0

Affiliation: University of Wisconsin–Madison

Abstract

Although intravenous digital subtraction angiography (IV-DSA), cone-beam CT, and rotational angiography are well-established technologies, using them in a single system in the hybrid operating room to acquire high-quality noninvasive 3D images is a recent development. This video demonstrates microsurgical excision of a ruptured cerebellar arteriovenous malformation (AVM) in a 66-year-old male followed by intraoperative IV-DSA acquisition using a new-generation system (Artis Icono). IV-DSA confirmed in real time that no residual remained following excision without the need to reposition the patient. To the best of the authors’ knowledge, this is the first surgical video to demonstrate the simplified workflow and application of this technology in neurovascular surgery.The video can be found here: https://youtu.be/bo5ya9DQQPw

Highlights

This surgical video demonstrates microsurgical excision of a hemorrhagic right cerebellar arteriovenous malformation in the hybrid operating room/ angiography suite
The system that we used, in this case, is Artis Icono, which is a new-generation angiography system. This system includes novel acquisition geometries focused on minimizing artifacts associated with cone-beam CT, including a sine geometry algorithm used for high-quality cone-beam CT and 3D digital subtraction angiography imaging obtained with intravenous contrast injection
With the advances made in both imaging quality and hybrid OR workflow with the Artis Icono system, we believe that IV 3D DSA is a critical tool in the arsenal for intraoperative management of complex neurovascular pathologies

Summary

Introduction

This surgical video demonstrates microsurgical excision of a hemorrhagic right cerebellar arteriovenous malformation in the hybrid operating room/ angiography suite. We utilized intraoperative intravenous 3D digital subtraction angiography to confirm in real time that no residual remained following excision. IV-DSA has made several advancements over the years, and in patients where arterial access is contraindicated or in the hybrid OR setting where rapid and convenient imaging is critical, it is a viable option.

Results

Conclusion