Safety and Feasibility Assessment of the O-Arm as an Intraoperative Angiography Device in Aneurysm Surgery

Torné, Ramón; García, Sergio; L, San-Román; Rodríguez-Hernández, Ana; Reyes, Luís; Tercero, Javier; Enseñat, Joaquim

doi:10.1016/j.wneu.2019.04.076

Cited by 6 publications

(2 citation statements)

References 24 publications

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“…In addition to its originally intended purpose of providing stereotactic navigation for instrumentation placement in the spine, the O-arm has been recently used for the assessment of vascular anatomy. For instance, in 2019, Torne et al demonstrated the effectiveness of the O-arm in visualizing intra-cranial aneurysms [ 10 ]. In 2020, Pavlov et al proposed the idea of using the O-arm to visualize the VA in spine surgery [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Stereotactic Arteriography in Complex Cervical Spine Surgery

Mugge,

Dang,

Ziu

et al. 2024

Cureus

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Intra-operative navigation has revolutionized spinal instrumentation. The O-arm (a mobile X-ray system; Medtronic, Minneapolis, MN) is uniquely capable of enabling visualization of the spine in axial planes. The application of this technology is wide yet underutilized in terms of its capacity to image spinal vascular anatomy. We completed a retrospective chart review of the following case studies. A 24-year-old neurologically intact female presented with a Jefferson fracture without vertebral artery dissection after a motor vehicle accident. After the failure of conservative management due to pseudoarthrosis, the patient opted for fusion. Prior to the procedure, bilateral 5 French femoral sheaths were placed. After exposure, intraarterial (IA) contrast was injected prior to the O-arm spin to visualize both vertebral arteries, which were stretched and adjacent to a mobile boney segment. In the second case, a 71-year-old male presented with right shoulder pain and a flaccid left deltoid secondary to a large enhancing epidural lesion spanning C4-C7. Further work-up confirmed a diagnosis of metastatic intrahepatic cholangiocarcinoma. Prior to resection with cervical spinal stabilization, a right radial artery 4 French Glidesheath was placed. Prior to the O-arm spin, the right vertebral artery was selected, and intravenous contrast was injected to permit visualization of the vertebral artery, which was encased within the tumor and at significant risk for iatrogenic injury. Both patients tolerated the endovascular and spinal procedures well without vertebral artery injury. This is the first series to report the effective use of the O-arm for improved visualization of vascular anatomy during surgery for cervical spinal trauma and oncology.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Stereotactic Arteriography in Complex Cervical Spine Surgery

Mugge,

Dang,

Ziu

et al. 2024

Cureus

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“…Besides the diagnosis and treatment of vascular pathologies (Torné et al 2019), even stereotactic procedures demonstrated to benefit from the use of 3D-DSA. This is especially the case of SEEG, an invasive procedure in which about 10-20 intracerebral electrodes are percutaneously implanted in the brain region.…”

Section: Introductionmentioning

confidence: 99%

Validation of SART 3.5D algorithm for cerebrovascular dynamics and artery versus vein classification in presurgical 3D digital subtraction angiographies

et al. 2022

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Classification of arteries and veins in cerebral angiograms can increase the safety of neurosurgical procedures, such as StereoElectroEncephaloGraphy, and aid the diagnosis of vascular pathologies, as arterovenous malformations. We propose a new method for vessel classification using the contrast medium dynamics in standard Digital Subtraction Angiography (DSA). After 3D DSA and angiogram segmentation, contrast enhanced projections are processed to suppress soft tissue and bone structures attenuation effect and further enhance the contrast medium flow. For each voxel labelled as vessel, a Time Intensity Curve (TIC) is obtained as a linear combination of temporal basis functions whose weights are addressed by Simultaneous Algebraic Reconstruction Technique (SART 3.5D), expanded to include dynamics. Each TIC is classified by comparing the areas under the curve in the arterial and venous phases. Clustering is applied to optimize the classification thresholds. On a dataset of 60 patients, a median value of sensitivity (90%), specificity (91%), and accuracy (92%) were obtained with respect to manually annotated arterial and venous voxels up to branching order 4-5. Qualitative results are also presented about CM arrival time mapping and its distribution in arteries and veins respectively. In conclusion, this study shows a valuable impact, at no protocol extra-cost or invasiveness, concerning surgical planning related to the enhancement of arteries as major organs at risk. Also, it opens a new scope on the pathophysiology of cerebrovascular dynamics and its anatomical relationships.

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