Coenen V A, Dammert S, Reinges M H T, Mull M, Gilsbach J M, Rohde V
Department of Neurosurgery, University Hospital, Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
Neuroradiology. 2005 Jan;47(1):66-72. doi: 10.1007/s00234-004-1307-y. Epub 2005 Jan 11.
In small arteriovenous malformations (AVM) with large hematomas, surgery remains the main therapeutic option. However, intraoperative identification of the AVM, feeders, and draining veins could be difficult in the environment of substantial intracerebral blood. In those selected cases, we use navigated computed tomographic angiography (CTA) for the microneurosurgical management. It is our objective to report our initial experiences. Prior to operation a conventional CTA with superficial skin fiducials placed on a patient's head was acquired for diagnostic and neuronavigation purposes. Image data were transferred to a neuronavigation device with integrated volume rendering capacities which allows a three-dimensional reconstruction of the vascular tree and the AVM to be created. In all patients the AVM was removed successfully after having been localized with CTA-based neuronavigation. Navigated CTA is helpful for the operative management of small AVMs with large hematomas. The technique allows feeding arteries to be distinguished from draining veins thereby allowing the nidus of the AVM to be identified despite the presence of substantial intracerebral blood. CTA can be easily implemented into commercial neuronavigation systems.
对于伴有大血肿的小型动静脉畸形（AVM），手术仍是主要的治疗选择。然而，在脑内大量出血的情况下，术中识别AVM、供血动脉和引流静脉可能会很困难。在那些特定病例中，我们使用导航计算机断层血管造影（CTA）进行显微神经外科治疗。我们的目的是报告我们的初步经验。术前，为了诊断和神经导航目的，获取了在患者头部放置了浅表皮肤标记物的常规CTA。图像数据被传输到具有集成容积再现功能的神经导航设备，该设备可以创建血管树和AVM的三维重建。在所有患者中，基于CTA的神经导航定位后，AVM均成功切除。导航CTA有助于伴有大血肿的小型AVM的手术治疗。该技术能够区分供血动脉和引流静脉，从而即使存在大量脑内出血也能识别AVM的病灶。CTA可以很容易地应用于商业神经导航系统。
