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Intraoperative angiography in the management of pediatric vascular disorders
1Division of Neurosurgery, Children's Hospital of Los Angeles, Los Angeles, Calif., USA.
Insights
Intraoperative angiography aids pediatric neurosurgery for cerebral aneurysms and arteriovenous malformations (AVMs). This imaging technique offers critical intraoperative information, improving surgical outcomes for vascular disorders in children.
Area of Science:
- Pediatric Neurosurgery
- Neuroradiology
- Vascular Surgery
Background:
- Cerebral aneurysms and arteriovenous malformations (AVMs) are significant vascular disorders in children.
- Effective surgical management of these conditions requires precise anatomical and vascular detail.
Purpose of the Study:
- To evaluate the utility and impact of intraoperative angiography in the surgical management of pediatric cerebral aneurysms and AVMs.
- To assess changes in surgical strategy and patient outcomes resulting from intraoperative angiographic findings.
Main Methods:
- Retrospective review of 22 pediatric cases (cerebral aneurysms and AVMs) over 5 years.
- Analysis of intraoperative angiography use, impact on surgical decisions, operative time, and complications.
Main Results:
- Intraoperative angiography provided crucial information leading to surgical changes in 4 of 22 cases.
- Identified residual AVMs in 3 cases for complete resection and guided clip repositioning in 1 aneurysm case.
- Added an average of 43 minutes to operative time with one minor, resolved complication (groin hematoma).
Conclusions:
- Intraoperative angiography is a valuable adjunct in pediatric neurovascular surgery, despite increasing operative time.
- Routine use of intraoperative angiography is recommended for surgical management of pediatric vascular malformations.
- This technique enhances surgical precision and potentially improves outcomes for complex pediatric vascular lesions.
Abstract:
We reviewed our experience with intraoperative angiography in the management of 7 cerebral aneurysms and 15 arteriovenous malformations (AVMs) in children over the past 5 years. The patients ranged from 4 months to 18 years of age with a mean age of 9 years. In 4 of the 22 cases, angiography provided information that led to changes during surgery. In 3 cases, the intraoperative angiogram revealed residual AVMs that were then completely resected. In 1 patient with an anterior circulation aneurysm, intraoperative studies revealed findings which resulted in clip repositioning. Intraoperative angiography added a mean of 43 (+/-19) min to the operative time, with a mode of 40 minutes. There was 1 complication, a groin hematoma that readily resolved. Intraoperative angiography prolongs to operative course; however, it is a useful adjunct to the management of vascular disorders in children. We now routinely use and recommend intraoperative angiography to assist with the surgical management of vascular malformations in children.