Role of Frameless Stereotaxy in the Surgical Treatment of Cerebral Arteriovenous Malformations: Technique and Outcomes in a Controlled Study of 44 Consecutive Patients

Russell, Stephen; Woo, Henry H.; Joseffer, Seth S.; Jafar, Jafar J.

doi:10.1097/00006123-200211000-00002

Cited by 47 publications

(19 citation statements)

References 23 publications

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“…The elucidation of the complex anatomy of AVMs by neuronavigation provides a more reliable verification of the resection margins with minimal disruption to the normal brain architecture, reducing the duration of brain retraction and the morbidity related to the surgical approach. 12 Conventional DSA provides superior spatial and temporal resolution of fine vascular anatomy less than 3 mm, relative to both CTA and MRA. 1,19,20 Imaging of The abrupt acute angle of the LSA at its origin and its small caliber prevented canalization of the artery with a microcatheter for liquid embolization.…”

Section: Discussionmentioning

confidence: 99%

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Stidd¹,

Wewel²,

Ghods³

et al. 2014

JNS

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Paralleling the rapid development of neuroimaging technology, the introduction of neuronavigation in the 1980s has revolutionized the surgery of intracranial diseases.2,11 Neuronavigation based on CT or MRI studies has tailored surgical interventions to individual anatomy and pathology, with minimal disruption to the physical and functional architecture of the brain. Vascular anatomy is best appreciated with digital subtraction angiography (DSA), which remains the gold standard for imaging of cerebrovascular pathology. Both CT angiography (CTA) and MR angiography (MRA) have lower detection sensitivity and inferior spatial resolution relative to DSA for aneurysms smaller than 3 mm. 1,19,20 The use of DS angiograms as source images for neuronavigation, however, has been limited because DSA studies typically lack the soft-tissue information necessary to register the radiographic image space to the head in the physical space. Images from DSA typically require fusion with CT or MR images for coregistration.Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration Object. Cerebrovascular lesions can have complicated abnormal anatomy that is not completely characterized by CT or MR angiography. Although 3D rotational angiography provides superior spatial and temporal resolution, catheter angiograms are not easily registered to the patient, limiting the use of these images as a source for neuronavigation. However, 3D digital subtraction angiography (DSA) contains not only vascular anatomy but also facial surface anatomy data. The authors report a novel technique to register 3D DSA images by using only the surface anatomy contained within the data set without having to fuse the DSA image set to other imaging modalities or use fiducial markers.Methods. A cadaver model was first created to assess the accuracy of neuronavigation based on 3D DSA images registered by facial surface anatomy. A 3D DSA scan was obtained of a formalin-fixed cadaver head, with acquisitions of mask and contrast runs. The right common carotid artery was injected prior to the contrast run with a 45% contrast solution diluted with water-soluble red liquid latex. One week later, the head was registered to a neuronavigation system loaded with the 3D DSA images acquired earlier using facial surface anatomy. A right pterional craniotomy was performed and 10 different vascular landmarks were identified and measured for accuracy using the neuronavigation system. Neuronavigation based only on 3D DSA was then used to guide an open clipping procedure for a patient who presented with a ruptured distal lenticulostriate aneurysm.Results. The accuracy of the measurements for the cadaver model was 0.71 ± 0.25 mm (mean ± SE), which is superior to the 1.8-5 mm reported for neuronavigation. The 3D DSA-based navigation-assisted surgery for the distal lenticulostriate aneurysm aided in localization, resulting in a small craniotomy and minimal brain dissection.Conclusions. This is the first example of frameless neu...

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Section: Discussionmentioning

confidence: 99%

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Stidd¹,

Wewel²,

Ghods³

et al. 2014

JNS

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show abstract

“…The optical definition and anatomical projection of the vascular lesion with this technique is also superior to that of DSA alone. Furthermore, the correlation of the 3D volume-rendering CT angiography with the intraoperative findings is excellent, as has already been discussed by one of the authors in a recently published paper (28) as well as by others (4)(5)(6)(7)11,12,15,17,25). With respect to the system's accuracy, it seems to be similar to that of the IGS system, although we do not yet have sufficient data to support a statistical appraisal.…”

Section: Discussionmentioning

confidence: 57%

Image-guided microneurosurgical management of vascular lesions using navigated computed tomography angiography. an advanced IGS technology application

Chibbaro

Tacconi

2006

Int. J. Med. Robotics Comput. Assist. Surg.

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“…Важным яв-ляется выбор оптимального вида лечения АВМ или их сочетания у конкретного больного. При этом основной задачей является исключение АВМ из кровотока голо-вного мозга без ухудшения неврологического статуса (в идеале), что удается не всегда [8][9][10][11][12][13][14][15].…”

Section: статья содержит рисунки которые отображаются в печатной верunclassified

Multiple stage treatment arteriovenous malformations rupture with intracerebral hematoma formations: a case report

Dzenis¹,

Kupchs²,

Arajuma³

2017

Ukr Neurosurg J

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Role of Frameless Stereotaxy in the Surgical Treatment of Cerebral Arteriovenous Malformations: Technique and Outcomes in a Controlled Study of 44 Consecutive Patients

Cited by 47 publications

References 23 publications

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Image-guided microneurosurgical management of vascular lesions using navigated computed tomography angiography. an advanced IGS technology application

Multiple stage treatment arteriovenous malformations rupture with intracerebral hematoma formations: a case report

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