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Real-time image guidance for open vascular neurosurgery using digital angiographic roadmapping
Michael Ayad1, Arthur J Ulm, Tom Yao
1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Neurosurgery
|October 3, 2007
Summary
Angiographic roadmapping effectively guides surgical resection of brain and spine vascular lesions. This technique improves precision, minimizes bone removal, and aids in localizing difficult-to-see fistulae.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Medical Imaging
Background:
- Angiographic roadmapping superimposes live fluoroscopy onto a stored angiogram for catheter navigation.
- It is commonly used in endovascular procedures but not previously evaluated for surgical resection of neurovascular lesions.
Purpose of the Study:
- To evaluate angiographic roadmapping as an image-guided navigation tool for surgical resection of intracranial and spinal vascular lesions.
Main Methods:
- Retrospective review of 38 procedures in 35 patients undergoing surgical resection of vascular lesions using intraoperative roadmapping.
- The technique involved femoral/radial artery access, a portable C-arm, and a radiopaque instrument for precise lesion localization.
Main Results:
- Successfully used for various vascular lesions including arteriovenous malformations, fistulae, aneurysms, and vein of Galen malformations.
- Enabled precise incisions, reduced bone removal, localized small fistulae missed by MRI/CT, and confirmed complete resection.
- Facilitated immediate angiographic confirmation of complete resection.
Conclusions:
- Angiographic roadmapping is an effective intraoperative navigation tool for neurovascular lesion resection.
- It offers advantages over frameless stereotaxy for surgical guidance.
