University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Department of Neurosurgery, New York University School of Medicine, New York, New York, USA.
World Neurosurg. 2020 May;137:e358-e365. doi: 10.1016/j.wneu.2020.01.208. Epub 2020 Feb 4.
Verification of complete occlusion or resection of neurovascular lesions is often performed using intraoperative angiography. Surgery for spinal vascular lesions such as arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is typically performed with the patient in the prone position, making intraoperative angiography difficult. No standardized protocol is available for intraoperative angiography during spinal surgery with the patient in the prone position. We have described our experience using radial artery access for intraoperative angiography in thoracic spinal neurovascular procedures performed with the patient in the prone position.
We reviewed the data from all patients who had undergone surgical resection of spinal vascular lesions in the prone position with radial artery vascular access for intraoperative angiography. The patients were treated in a hybrid endovascular operating room.
A total of 4 patients were treated in the prone position using transradial artery access intraoperative angiography for confirmation of complete resection of the vascular lesions. Of the 4 patients, 2 had undergone surgery for a dural AVF, 1 for a pial AVF, and 1 for an AVM of the filum terminale. None of the patients had experienced any procedural complications.
Radial artery access for intraoperative angiography during spinal neurovascular procedures in which selective catheterization of a thoracic branch is necessary is feasible, safe, and practical.
神经血管病变的完全闭塞或切除的验证通常使用术中血管造影术进行。脊髓血管病变（如动静脉畸形（AVM）和动静脉瘘（AVF））的手术通常在患者俯卧位进行，这使得术中血管造影术变得困难。对于俯卧位下的脊髓手术，目前尚无术中血管造影的标准化方案。我们描述了在俯卧位下使用桡动脉入路进行术中血管造影的经验，用于进行胸段脊髓血管手术。
我们回顾了所有在杂交血管手术室内接受俯卧位经桡动脉入路术中血管造影以确认血管病变完全切除的脊髓血管病变患者的数据。
共有 4 名患者接受了经桡动脉入路的俯卧位术中血管造影，以确认血管病变的完全切除。4 名患者中，2 例为硬脑膜动静脉瘘，1 例为脑表面动静脉瘘，1 例为终丝动静脉畸形。所有患者均未发生任何手术并发症。
对于需要选择性导管插入胸段分支的脊髓血管手术，桡动脉入路进行术中血管造影是可行、安全且实用的。
