Intraoperative Spinal Digital Subtraction Angiography: Technique and Results

Benes, Ludwig; Wakat, Jörg-Peter; Sure, Ulrich; Bien, Siegfried; Bertalanffy, Helmut

doi:10.1227/01.neu.0000047893.56252.ff

Cited by 16 publications

(10 citation statements)

References 16 publications

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“…In the present case, there was access to a high-end angiography system, with which it would have been possible to apply 2-plane angiography, 3D rotational angiography or angiographic CT during the operation. In our hands, the presented method leads to (1) a shorter operation time, and (2) an increased image quality when compared to the previously described angiography within the operating room [2] . As neurosurgical approaches in an angiography suite are not performed frequently, there is no reliable data if the risk of infection is higher than in a proper operating room.…”

Section: Discussion ▼mentioning

confidence: 71%

“…However, to prevent thromboembolic events, a continuous fl ushing with saline of the long sheath as well as all other catheters is recommended. We have witnessed a prolongation of the entire procedure in cases in which a portable angiography device was used within the operating room [2] . A higher risk of injury during positioning of the legs was described in patients who received spinal surgery and were positioned in the prone position for longer than 2 h [10] .…”

Section: Discussion ▼mentioning

confidence: 99%

“…A higher risk of injury during positioning of the legs was described in patients who received spinal surgery and were positioned in the prone position for longer than 2 h [10] . Another disadvantage is the low imaging quality of the portable angiography device as compared to the images that are available in the angiography suite [2] . In the present case, there was access to a high-end angiography system, with which it would have been possible to apply 2-plane angiography, 3D rotational angiography or angiographic CT during the operation.…”

Section: Discussion ▼mentioning

confidence: 99%

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Indication, Technique and Benefit of Intraoperative Spinal Digital Subtraction Angiography with a new Setting in a Patient with Spinal Arteriovenous Malformation

et al. 2011

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Section: Discussion ▼mentioning

confidence: 71%

Section: Discussion ▼mentioning

confidence: 99%

Section: Discussion ▼mentioning

confidence: 99%

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Indication, Technique and Benefit of Intraoperative Spinal Digital Subtraction Angiography with a new Setting in a Patient with Spinal Arteriovenous Malformation

et al. 2011

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“…Prone positioning can also confuse the angiographer and make catheterization of the desired vessels dif fi cult. 16 An easy aid to catheterization is to reverse the fl uoroscopic image side-toside when working the catheter on a prone patient. These challenges may be overcome, but are one reason why intraoperative spinal angiography is not more commonly practiced.…”

Section: Intraoperative Spinal Angiographymentioning

confidence: 99%

Spinal Angiography

Harrigan

Deveikis

2012

Handbook of Cerebrovascular Disease and Neurointerventional Technique

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Catheter angiography of the spine is much less common than cerebral angiography, but it remains the gold standard for imaging spinal vasculature. Non-invasive imaging of spinal vasculature, including high resolution MRA or CTA, can sometimes be helpful to screen for larger vascular abnormalities, but fails to provide precise information regarding fl ow patterns and collateral fl ow; many times the vessels of interest are below the spatial resolution of these non-invasive modalities. Diagnostic spinal angiography is also typically done as the fi rst step during neurointerventional procedures involving the spine and spinal cord. The techniques and skills required for spinal angiography can overlap those required for cerebral angiography, since the upper cervical spine and spinal cord are supplied by the vertebral arteries. However, the spine extends from the base of the skull to the sacrum, and imaging the vasculature is a procedure entirely different from cerebral angiography. Indications1. Evaluation of patients with myelopathy, suspected to have spinal dural arteriovenous fi stulas (most common indication). 2. Evaluation of patients with known or suspected spinal arteriovenous malformations or vascular neoplasms (e.g., with spinal intramedullary or subarachnoid haemorrhages). 3. Rarely for evaluation of suspected spinal cord ischemia ischaemia (since cord blood supply is so variable, and treatment options for cord ischaemia are so limited, angiography is mainly done to rule out a fi stula as the cause of symptoms). 4. Planning for neurointerventional procedures on spine or spinal cord. 5. Pre-op mapping of cord vasculature prior to spinal or aortic procedures that risk occlusion of the spinal vessels. 6. Intra-operative assistance with surgery on spinal vascular lesions. 7. Follow-up imaging after treatment (e.g., after treatment of arteriovenous fi stulas or malformations). Complications of Diagnostic Spinal AngiographyInformed consent prior to an angiogram should include a discussion of the risk of complications. Neurological ComplicationsNeurological complications in spinal angiography may include the same risk of cerebral ischaemic events that may occur during cerebral angiography when the cervical region is being studied (see Chap. 2 ). In addition, there is the risk of vessel dissection, embolic occlusion with thrombus, atherosclerotic plaque, or air emboli occluding the spinal cord vessels and producing myelopathy. Forbes et al. reported that a series of 134 spinal angiograms had three (2.2%) neurological complications, all transient. spinal cord (although not necessarily performed as part of spinal angiography) has also been shown to produce temporary or permanent injury to the spinal cord. 4-6 Non-neurological ComplicationsNon-neurological complications of spinal angiography via the femoral artery include the same local and systemic complications seen in cerebral angiography (as seen in Chap. 2 ). Forbes reported 8.2% puncture-site complications and 3.7% systemic complications from spinal angiography.1 ...

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“…Também pode ser realizada de maneira segura a angiografia intraoperatória nos casos de recidiva ou lesões complexas (Benes, 2003).…”

Section: Angiografiaunclassified

Tratamento endovascular das malformações arteriovenosas raquimedulares: resultados clínicos e angiográficos

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Intraoperative Spinal Digital Subtraction Angiography: Technique and Results

Abstract: ISDSA is safe and effective, especially in surgery for complex vascular and recurrent malformations. Benefits to the patient outweigh the additional expense and prolongation of the surgical procedure.

Cited by 16 publications

References 16 publications

Indication, Technique and Benefit of Intraoperative Spinal Digital Subtraction Angiography with a new Setting in a Patient with Spinal Arteriovenous Malformation

Indication, Technique and Benefit of Intraoperative Spinal Digital Subtraction Angiography with a new Setting in a Patient with Spinal Arteriovenous Malformation

Spinal Angiography

Tratamento endovascular das malformações arteriovenosas raquimedulares: resultados clínicos e angiográficos

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