Yoon Wonki, Kim Hoon, Kim Young Woo, Kim Seong Rim, Park Ik Seong
Department of Neurological Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea.
Department of Neurosurgery, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon-si, Gyeonggi-do, Republic of Korea.
World Neurosurg. 2018 Mar;111:e799-e805. doi: 10.1016/j.wneu.2017.12.164. Epub 2018 Jan 5.
Digital subtraction angiography is the gold standard to confirm complete removal of an arteriovenous malformation (AVM) nidus. However, the transfemoral approach requires specialized instrumentation and is cumbersome and difficult to perform with the patient in the prone or decubitus position. We report the use of intraoperative digital subtraction angiography (iDSA) with the transradial approach and examine its usefulness and safety.
We retrospectively reviewed clinical features, radiologic images, surgical findings, and iDSA findings of patients with AVM who underwent surgery for nidus removal. Transradial iDSA was performed within 30 minutes for patients who required angiographic confirmation after AVM resection. This procedure was simple with the radial arterial line for blood pressure monitoring used as digital subtraction angiography catheter access route.
Transradial iDSA was performed in 23 patients. Twelve patients were not in the general supine position during neurosurgery; 7 patients were operated on in prone position, and 5 patients were operated on in the park bench position. Remnant nidus was identified by iDSA in 2 patients, and additional measures were required.
Intraoperative cerebral angiography during surgery for cerebral AVM could be performed safely via the transradial approach. This approach showed several merits in terms of easy access; no extra requirements, such as preoperative sheath implantation, anticoagulation during the surgery, or a radiolucent table; and usefulness in any surgical position. Further studies using this approach and comparison with the transfemoral approach are necessary.
数字减影血管造影是确认动静脉畸形（AVM）病灶完全切除的金标准。然而，经股动脉途径需要专门的器械，并且操作繁琐，在患者俯卧位或侧卧位时难以实施。我们报告经桡动脉途径术中数字减影血管造影（iDSA）的应用，并探讨其有效性和安全性。
我们回顾性分析了接受AVM病灶切除手术患者的临床特征、影像学图像、手术发现和iDSA结果。对于AVM切除后需要血管造影确认的患者，在30分钟内进行经桡动脉iDSA。该操作简单，将用于血压监测的桡动脉导管作为数字减影血管造影导管的接入途径。
23例患者接受了经桡动脉iDSA检查。12例患者在神经外科手术期间未处于常规仰卧位；7例患者在俯卧位进行手术，5例患者在公园长椅位进行手术。iDSA发现2例患者有残留病灶，需要采取额外措施。
经桡动脉途径可安全地在脑AVM手术中进行术中脑血管造影。该途径在以下方面显示出几个优点：易于操作；无需额外要求，如术前植入鞘管、术中抗凝或使用可透X线手术台；在任何手术体位均有用。有必要进一步研究该途径并与经股动脉途径进行比较。
