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Head Repositioning during Neurointerventional Procedures to Optimize Biplanar Imaging.

Ehsan Dowlati1, Tianzan Zhou1, Jeffrey Stewart1

  • 1Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
|July 9, 2020
PubMed
Summary

Simple head positioning adjustments can significantly improve working projections for neurointerventional procedures, aiding in the effective treatment of neurovascular pathology. This technique optimizes visualization during complex endovascular coiling treatments.

Keywords:
Biplane imaginganeurysmendovascular treatmenthead positioning

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Area of Science:

  • Neurosurgery
  • Interventional Neuroradiology
  • Vascular Neurology

Background:

  • Head positioning is crucial for surgical planning in cranial procedures.
  • Advances in biplane imaging have led to head positioning being an afterthought in neurointerventional cases.
  • Optimal working projections are essential for treating neurovascular pathology.

Purpose of the Study:

  • To demonstrate the application of head positioning in neurointerventional procedures.
  • To achieve optimal working projections for treating neurovascular pathology.
  • To improve endovascular treatment outcomes through enhanced visualization.

Main Methods:

  • Review of the senior author's operative log from 2016-2019.
  • Identification of 17 patients requiring head position readjustment for ideal working projections.
  • Categorization of repositioning adjustments based on patient reports and imaging.

Main Results:

  • Three specific head adjustments were utilized: head flexed, head extended, and extended-tilt positioning.
  • These adjustments facilitated optimal working projections using biplanar angiography.
  • All patients successfully underwent endovascular coiling for intracranial aneurysms.

Conclusions:

  • Ideal views of vascular pathology can be challenging due to biplane limitations or patient anatomy.
  • Simple head positioning maneuvers can achieve superior working projections.
  • Optimized endovascular treatment is facilitated by improved visualization through head positioning.