gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Clinical benefit in the management of ruptured and unruptured arterio-venous malformations in a combined imaging and surgical suite based on flat-panel technology

Meeting Abstract

  • Marc Kotowski - Department of Neurosurgery, University of Geneva, Medical Center, Medical Faculty of the University of Geneva, Switzerland
  • Bawarjan Schatlo - Department of Neurosurgery, University of Geneva, Medical Center, Medical Faculty of the University of Geneva, Switzerland
  • Max Jägersberg - Department of Neurosurgery, University of Geneva, Medical Center, Medical Faculty of the University of Geneva, Switzerland
  • Enrico Tessitore - Department of Neurosurgery, University of Geneva, Medical Center, Medical Faculty of the University of Geneva, Switzerland
  • Phillipe Bijlenga - Department of Neurosurgery, , University of Geneva, Medical Center, Medical Faculty of the University of Geneva, Switzerland
  • Vitor Pereira - Diagnostic & Interventional Neuroradiology, University of Geneva, Medical Center, Medical Faculty of the University of Geneva, Switzerland
  • Karl Schaller - Department of Neurosurgery, University of Geneva, Medical Center, Medical Faculty of the University of Geneva, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1525

DOI: 10.3205/10dgnc002, URN: urn:nbn:de:0183-10dgnc0020

Published: September 16, 2010

© 2010 Kotowski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: We report our preliminary experience of a prospective series of 17 patients who underwent combined neurointerventional and surgical procedures for arterio-venous malformation in a new hybrid imaging, endovascular and surgical suite which allows for diagnostic and 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 combined neurointerventional and surgical approaches with intraoperative high-speed CT-like imaging and intraoperative 3-D rotational angiography (up to 620 projections along 240° in 8–10 sec, rotational speed: 30°/55°/s, 30 frames/sec), automated segmentation of vascular structures and intraoperative update of a frameless navigation system (Brainlab VectorVision II). The impact of intraoperative imaging on treatment strategy, workflow and feasibility was evaluated using a prospective database.

Results: Seventeen patients harboring AVMs, 11 of them ruptured (mean Spetzler-grade: 1.8) and 5 unruptured (mean Spetzler-grade: 2.4) underwent combined endovascular and microsurgical procedures. In all patients, intraoperative 3-D RA has been performed before surgery and for resection control. Intraoperative 3-D RA has been used for segmentation of vascular structures and intraoperative update of navigation. 2 patients have been treated by embolisation followed by surgery in the same session. In 15.7% (n=3 patients) intraoperative 3-D RA has led to additional resection of AVM remnants. One patient suffered from a post-operative infection, three patients suffered from transient focal deficit. One patient suffered from a permanent neurological deficit appeared after surgery. A complete excision rate of 100% has been achieved.

Conclusions: A combined neurointerventional suite based on flat-panel technology is of particular value for combined neurointerventional and surgical treatment of cerebral AVMs. It allows for a combination of endovascular embolisation and surgery in one session and intraoperative resection control. It improves the management of arterio-venous malformation in terms of the (peri-) interventional workflow, and by preventing the necessity for extraoperatvie angiographic control with potential revision in a second operation.