Villelli Nicolas W, Lewis David M, Leipzig Thomas J, DeNardo Andrew J, Payner Troy D, Kulwin Charles G
1Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis; and.
2Goodman Campbell Brain and Spine, Indianapolis, Indiana.
J Neurosurg Spine. 2018 Sep;29(3):322-326. doi: 10.3171/2018.1.SPINE171257. Epub 2018 Jun 15.
OBJECTIVE Intraoperative angiography can be a valuable tool in the surgical management of vascular disorders in the CNS. This is typically accomplished via femoral artery puncture; however, this can be technically difficult in patients in the prone position. The authors describe the feasibility of intraoperative angiography via the popliteal artery in the prone patient. METHODS Three patients underwent intraoperative spinal angiography in the prone position via vascular access through the popliteal artery. Standard angiography techniques were used, along with ultrasound and a micropuncture needle for initial vascular access. Two patients underwent intraoperative angiography to confirm the obliteration of dural arteriovenous fistulas. The third patient required unexpected intraoperative angiography when a tumor was concerning for a vascular malformation in the cervical spine. RESULTS All 3 patients tolerated the procedure without complication. The popliteal artery was easily accessed without any adaptation to typical patient positioning for these prone-position cases. This proved particularly beneficial when angiography was not part of the preoperative plan. CONCLUSIONS Intraoperative angiography via the popliteal artery is feasible and well tolerated. It presents significant benefit when obtaining imaging studies in patients in a prone position, with the added benefit of easy access, familiar anatomy, and low concern for catheter thrombosis or kinking.
目的 术中血管造影术可成为中枢神经系统血管疾病外科治疗中的一项重要工具。这通常通过股动脉穿刺来完成；然而，对于俯卧位患者而言，这在技术上可能具有挑战性。作者描述了在俯卧位患者中经腘动脉进行术中血管造影术的可行性。方法 3例患者在俯卧位下经腘动脉血管穿刺进行术中脊髓血管造影。使用了标准的血管造影技术，以及超声和微穿刺针用于初始血管穿刺。2例患者进行术中血管造影以确认硬脑膜动静脉瘘的闭塞。第3例患者在肿瘤疑似颈椎血管畸形时需要进行意外的术中血管造影。结果 所有3例患者均耐受该操作，无并发症发生。在这些俯卧位病例中，无需对典型患者体位进行任何调整即可轻松穿刺腘动脉。当血管造影术并非术前计划的一部分时，这一点尤其有益。结论 经腘动脉进行术中血管造影术是可行的，且耐受性良好。在为俯卧位患者进行影像学检查时，它具有显著优势，还具有易于穿刺、解剖结构熟悉以及导管血栓形成或扭结风险低等额外优势。
