Intraoperative selective cerebral angiography for microsurgical treatment of cerebral arteriovenous malformations in a hybrid operating room

Abstract

Arteriovenous malformations (AVMs) of the brain are a congenital anomaly of the development of cerebral vessels, when instead of a normal capillary bed, a «network» of pathologically altered vessels is formed, through which arterial blood is shunted into the drainage venous system. Due to the thinned wall of the pathological vessels and high pressure in them, patients with AVMs are at risk of intracerebral hemorrhage up to 4 % annually, which determines the vital need for their treatment. Microsurgical removal of brain AVMs is considered the most radical and effective treatment method, the main goal of which is to completely disable the body of the malformation, since the remaining part can lead to the risk of postoperative bleeding. To ensure effective control over the completeness of AVM removal intraoperatively, two methods have been developed: selective cerebral angiography (SCAG) and indocyanine green video angiography (ICG-VA). According to the literature, SCAG provides a number of advantages in the intraoperative diagnosis of residual AVM parts compared to ICG-VA. The article analyzes our own experience in using intraoperative SCAG in the surgical treatment of AVM in a hybrid operating room and examines the literature data on the topic of the paper. Our study highlights the importance of using the method of intraoperative control through SCAG in order to improve the effectiveness of surgical treatment of cerebral AVMs.