Intraoperative Angiography for Arteriovenous Malformation Resection in the Prone and Lateral Positions, Using Upper...

Area of Science:

• Neurosurgery
• Vascular Surgery
• Interventional Radiology

Background:

• Intraoperative angiography is crucial for assessing aneurysms and arteriovenous malformations (AVMs).
• Performing angiography in the prone position for spinal and posterior fossa surgery presents challenges.
• A standardized protocol for intraoperative angiography in the prone position is lacking.

Purpose of the Study:

• To evaluate the utility of intraoperative angiography in prone and lateral positions.
• To assess the safety and efficacy of using upper extremity arterial access for this procedure.

Main Methods:

• A retrospective review of patients undergoing intraoperative angiography between 2014 and 2015.
• Vascular access was obtained via brachial or radial arteries using ultrasonographic guidance and 4F sheaths.
• Procedures were performed in a hybrid endovascular operating room for high cervical and intracranial lesions.

Main Results:

• Five patients with various neurovascular lesions (AVMs, AVFs) were treated in prone or lateral positions.
• Brachial or radial artery access was successfully used in all cases.
• Intraoperative angiography confirmed complete occlusion/resection in all patients without complications.

Conclusions:

• Intraoperative angiography via upper extremity access is a valuable adjunct for prone and lateral neurovascular surgeries.
• Brachial or radial artery access is safe, comfortable, and efficient.
• This approach facilitates accurate assessment of treatment success for complex neurovascular lesions.