Intraoperative biplanar rotational angiography during neurovascular surgery

Technical note

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  • 1 Divisions of Neurosurgery and
  • 2 Neuroradiology, Toronto Western Hospital; and
  • 3 University of Toronto, Toronto, Ontario, Canada
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Object

The purpose of this study was to evaluate the authors' initial experience with the integration of high-resolution rotational and biplanar angiography during neurovascular operative procedures.

Methods

Eight patients with intracerebral arteriovenous malformations (AVMs) and aneurysms underwent surgical treatment of their lesions in a combined endovascular surgical suite. After initial head positioning, preoperative biplane and rotational angiography was performed. Resection of the AVM or clipping of the aneurysm was then performed. Further biplane and rotational 3D angiograms were obtained intraoperatively to confirm satisfactory treatment.

Results

One small residual AVM identified intraoperatively necessitated further resection. One aneurysm was clipped during endovascular inflation of an intracarotid balloon for temporary proximal control. The completeness of treatment was confirmed on intraoperative 3D rotational angiography in all cases, and there were no procedure-related complications.

Conclusions

Intraoperative rotational angiography performed in an integrated biplane angiography/surgery suite is a safe and useful adjunct to surgery and may enable combining endovascular and surgical procedures for the treatment of complex vascular lesions.

Abbreviations used in this paper: AVM = arteriovenous malformation; DS = digital subtraction.

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Contributor Notes

Address correspondence to: Michael Tymianski, M.D., Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, 4th Floor, University of Toronto, Toronto, Ontario M5T 2S8, Canada. email: mike.tymianski@uhn.on.ca.
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