Lopez Kim A, Waziri Allen E, Granville Robert, Kim Grace H, Meyers Philip M, Connolly E Sander, Solomon Robert A, Lavine Sean D
Department of Neurological Surgery, Columbia University Medical Center, New York, New York 10032, USA.
Neurosurgery. 2007 Oct;61(4):724-9; discussion 729-30. doi: 10.1227/01.NEU.0000298900.84720.D0.
The routine use of intraoperative angiography (IA) is still surrounded by controversy. We prospectively performed IAs in consecutive patients undergoing surgery for aneurysms, arteriovenous malformations, and dural arteriovenous fistulae. We calculated the percentage of identified residual pathologies, the cases requiring further surgical intervention, and the complication rates associated with the procedure. We also recorded radiation dose received by personnel during IA for comparison with elective procedures. If our review supported the routine use of IA, recommendations should be tempered by radiation dose to personnel regarding whether or not annual exposure would go beyond recommended limits and whether or not radiation doses indicate a need for specialized operating rooms.
Two hundred and four consecutive IAs were performed on 191 patients over a 2-year period. Angiographic findings were reviewed retrospectively and noted for additional interventions. Complications related to IA were recorded. Radiation doses received by personnel and fluoroscopy times were compiled from 18 IAs. Mean dose/minutes in intraoperative procedures was compared with mean dose/minutes of a separate cohort of 15 elective angiograms (Student's t test).
Twenty-three percent of IAs revealed relevant findings. Clip repositioning or additional clip placement was performed in 8% of the patients. Resection of residual arteriovenous malformations or additional surgery for residual arteriovenous shunting in dural arteriovenous fistulae was performed in 2% of the patients. Fewer than 1% of the patients received intra-arterial verapamil or topical papaverine. The complication rate was less than 1%. The mean dose per procedure for physicians was 1.018 microsieverts (uSv) versus 0.988 uSv for technicians (P = 0.94). The mean effective dose/minutes in the angiogram suite was 0.9209 uSv/minute versus 1.213 uSv/minute in the operating room (P = 0.33).
IA identifies a significant number of pertinent findings during open neurovascular surgery, half of which require additional intervention. It is associated with a low complication rate. Radiation dose received by personnel per procedure is negligible. IA radiation dose is not different from dose in the angiogram suite; thus, specialized operating rooms may not be necessary. These data support routine intraoperative angiography in open surgeries for neurovascular disorders.
术中血管造影（IA）的常规使用仍存在争议。我们对连续接受动脉瘤、动静脉畸形和硬脑膜动静脉瘘手术的患者前瞻性地进行了IA检查。我们计算了已识别的残余病变的百分比、需要进一步手术干预的病例以及与该操作相关的并发症发生率。我们还记录了IA期间工作人员接受的辐射剂量，以便与择期手术进行比较。如果我们的综述支持IA的常规使用，那么在考虑工作人员的辐射剂量时，应权衡建议，即年度暴露是否会超过推荐限值，以及辐射剂量是否表明需要专门的手术室。
在2年期间，对191例患者连续进行了204次IA检查。对血管造影结果进行回顾性分析，并记录额外的干预措施。记录与IA相关的并发症。从18次IA检查中汇总工作人员接受的辐射剂量和透视时间。将术中操作的平均剂量/分钟与另一组15次择期血管造影的平均剂量/分钟进行比较（学生t检验）。
23%的IA检查发现了相关结果。8%的患者进行了夹子重新定位或额外放置夹子。2%的患者进行了残余动静脉畸形切除术或硬脑膜动静脉瘘残余动静脉分流的额外手术。不到1%的患者接受了动脉内维拉帕米或局部罂粟碱治疗。并发症发生率低于1%。医生每次操作的平均剂量为1.018微西弗（μSv），技术人员为0.988 μSv（P = 0.94）。血管造影室的平均有效剂量/分钟为0.9209 μSv/分钟，而手术室为1.213 μSv/分钟（P = 0.33）。
IA在开放性神经血管手术期间发现了大量相关结果，其中一半需要额外干预。它的并发症发生率较低。每次操作工作人员接受的辐射剂量可以忽略不计。IA辐射剂量与血管造影室的剂量没有差异；因此，可能不需要专门的手术室。这些数据支持在开放性神经血管疾病手术中常规进行术中血管造影。
