gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Optimized management of patients with ruptured and unruptured aneurysms in a combined imaging and surgical suite

Meeting Abstract

  • M. Kotowski - Service de Neurochirurgie, Hopitaux Universitaires de Geneve, Suisse, Faculte de Medicine d'Universite de Geneve
  • B. Schatlo - Service de Neurochirurgie, Hopitaux Universitaires de Geneve, Suisse, Faculte de Medicine d'Universite de Geneve
  • M. Jaegersberg - Service de Neurochirurgie, Hopitaux Universitaires de Geneve, Suisse, Faculte de Medicine d'Universite de Geneve
  • E. Tessitore - Service de Neurochirurgie, Hopitaux Universitaires de Geneve, Suisse, Faculte de Medicine d'Universite de Geneve
  • P. Bijlenga - Service de Neurochirurgie, Hopitaux Universitaires de Geneve, Suisse, Faculte de Medicine d'Universite de Geneve
  • C. Schaller - Service de Neurochirurgie, Hopitaux Universitaires de Geneve, Suisse, Faculte de Medicine d'Universite de Geneve

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.02-01

DOI: 10.3205/09dgnc111, URN: urn:nbn:de:0183-09dgnc1115

Published: May 20, 2009

© 2009 Kotowski et al.
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Outline

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Objective: The treatment of acute subarachnoid haemorrhage includes patient transfer for diagnostic and therapeutic facilities. This may be especially cumbersome in critically unstable patients. Thus, we aimed for the development of a combined imaging, endovascular and surgical suite, which allows for diagnostic imaging as well as intraoperative imaging (CT and 3-D rotational angiography).

Methods: We combined recent Flat-Panel technology (Philips Allura Xper FD 20) with a sterile surgical and neurointerventional environment. It allows for intraoperative high-speed image acquisition (up to 620 projections along 240° in 8–10 sec, rotational speed: 30°/55°/s, 30 frames/sec) and automated segmentation of vascular structures. N=42 patients harbouring 57 aneurysms underwent treatment within this setup (n=30 clipping, n=9 endovascular, n=3 combined endovascular/surgical), a total amount of n=63 intraoperative 3-D angiographies has been performed.

Results: Time from diagnosis to treatment was reduced in all acute cases as admission CT imaging with the flat-panel detector could be performed at the same location as subsequent endovascular and/or surgical treatment as well as angiographic control (n=42). External ventricular drain placement was performed immediately after admission XperCT (n=1). Neurosurgical or neurointerventional treatment or combined approaches were performed on acute and elective cases, e.g. clipping with proximal endovascular control or combined embolisation/clipping (n=30 clipping, n=9 coiling, n=3 combined). Intraoperative 3-D-rotational angiography was performed in n=42 patients <15 min. It allowed for direct control of aneurysm clipping with an open situs and ruled out incomplete clipping (n=6), vascular compromise (n=1) or insufficiently coiled neck remnants (n=2). Direct repositioning of aneurysm clips (n=9) was performed in n=6 patients. Finally, intraoperative 3-D angiography led in 18,8 % to discovery of clip-related complications, to clip repositioning and thus, to reduction of revisions. A complete clip occlusion rate of 100% has been achieved after the first intervention.

Conclusions: A combined neurointerventional suite is of particular value for treatment of cerebral aneurysms. It improves the overall management of aneurysmal subarachnoid haemorrhage and aneurysms in terms of the (peri-) interventional workflow, and by preventing the necessity for extraoperative angiographic control with potential revision in a second operation.