Ayad Michael, Ulm Arthur J, Yao Tom, Eskioglu Eric, Mericle Robert A
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Neurosurgery. 2007 Sep;61(3 Suppl):55-61; discussion 61-2. doi: 10.1227/01.neu.0000289714.18297.41.
Angiographic roadmapping, commonly used for catheter navigation in endovascular procedures, is the superimposition of a live fluoroscopic image on a previously stored digitally subtracted angiogram. We evaluated this technique for the first time as a method for image-guided navigation during surgical resection of intracranial and spinal vascular lesions.
After obtaining Institutional Review Board approval, we retrospectively reviewed 38 procedures in 35 patients at two centers performed by one neurosurgeon in which intraoperative roadmapping was used as an image-guided navigation tool for surgical resection of cranial and spinal arteriovenous malformations or fistulae. This technique requires femoral or radial artery access and a portable vascular C-arm capable of digitally subtracted angiogram and roadmap angiography in the operating room suite. Once a roadmap identifying the vascular lesion is obtained, a sterile radiopaque instrument is placed over the skin/wound to precisely localize the lesion in multiple dimensions.
Angiographic roadmapping was used for resection of seven spinal arteriovenous malformations or fistulae, 23 cranial arteriovenous malformations or fistulae, one aneurysm, two carotid-cavernous fistulae, and transtorcular embolization of five vein of Galen malformations. In all cases, the technique helped us to make precisely localized incisions, avoid unnecessary bone removal, and readily directed us to the vascular lesion. In several cases, it allowed localization of small fistulae not visible on magnetic resonance imaging or computed tomographic angiography scans. Finally, this approach facilitated immediate angiographic confirmation of complete resection at the end of each case.
Angiographic roadmapping is an effective intraoperative navigation tool for resection of vascular lesions that has not been previously described and offers several advantages to frameless stereotaxy.
血管造影路线图技术常用于血管内介入手术中的导管导航，是将实时荧光透视图像叠加在先前存储的数字减影血管造影图像上。我们首次评估了该技术作为颅内和脊柱血管病变手术切除过程中图像引导导航方法的效果。
获得机构审查委员会批准后，我们回顾性分析了两个中心由一位神经外科医生实施的35例患者的38例手术，术中使用路线图技术作为手术切除颅和脊柱动静脉畸形或瘘的图像引导导航工具。该技术需要经股动脉或桡动脉穿刺，并在手术室配备一台能够进行数字减影血管造影和路线图血管造影的便携式血管C形臂。一旦获得识别血管病变的路线图，将一个无菌不透射线器械放置在皮肤/伤口上方，以便在多个维度上精确确定病变位置。
血管造影路线图技术用于切除7例脊柱动静脉畸形或瘘、23例颅动静脉畸形或瘘、1例动脉瘤、2例颈内动脉海绵窦瘘，以及对5例大脑大静脉畸形进行经窦栓塞。在所有病例中，该技术帮助我们精确地进行切口定位，避免不必要的骨质切除，并能迅速引导我们找到血管病变。在几例病例中，它能定位出磁共振成像或计算机断层血管造影扫描中不可见的小瘘口。最后，这种方法有助于在每例手术结束时立即通过血管造影确认完全切除。
血管造影路线图技术是一种有效的术中导航工具，可用于切除血管病变，此前尚未见相关描述，与无框架立体定向技术相比具有若干优势。
