gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Navigation of donor vessels in extra-intracranial bypass surgery

Meeting Abstract

Suche in Medline nach

  • B. Wasielewski - Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • P. Horn - Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • P. Vajkoczy - Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.07-07

DOI: 10.3205/09dgnc159, URN: urn:nbn:de:0183-09dgnc1592

Veröffentlicht: 20. Mai 2009

© 2009 Wasielewski et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Revascularization is an integral component for the treatment of vascular pathologies, such as haemodynamic cerebral ischemia, complex aneurysms, or skull base tumors. Many of the applied revascularization procedures use branches of the superior temporal artery (STA) or occipital artery (OA) as donor vessels. Precise pre-surgical mapping/identification of the donor vessel is crucial for individually tailoring the skin incision, limiting the surgical trauma, reducing the risk of donor vessel violation, and shortening of the surgical time. Here we investigate a novel technique for exact and reliable donor vessel localization using Neurovascular Navigation.

Methods: Of 38 patients that were scheduled for microsurgical revascularization and underwent pre-surgical CT-angiography 17 (13 for STA-MCA and 4 for OA-PICA bypass) received consecutive 3D reconstruction with BrainLab iPlan software for navigation of the extracranial donor arteries. The course of the donor arteries was determined using the VectorVision II system. The skin incision in those patients was performed with respect to the delineated donor vessel. The precision of Neurovascular Navigation was compared to vessel palpation for STA-MCA bypasses or microdoppler sonography for OA-PICA bypasses. Operation time and preparation time in the operation theatre were compared between navigated and not navigated cases.

Results: In the 13 patients with STA-MCA bypass surgery the donor vessel was located as determined by navigation with a maximal deviation of 0–5mm, differing up to more than 10mm from the course estimated by palpation. In the 4 patients with OA-PICA bypass surgery palpation and microdoppler detection of the occipital artery failed at all, whereas navigation revealed the exact vessel localization. Operation time with navigation was progressively reduced and preparation time was not significantly increased. Neurovascular Navigation allowed to place the skin incision exactly along the course of the donor vessel in all cases and simplified vessel preparation, especially in the case of OA bypasses.

Conclusions: Neurovascular Navigation is a reliable and timesaving tool for exact localization and safe preparation of extracranial donor arteries in bypass surgery. Based on our results Neurovascular Navigation is superior to palpation (in STA-MCA) and microdoppler sonography (in OA-PICA bypass).