gms | German Medical Science

Objective: The main goal of the present study was to evaluate the potential of intraoperative angiography (conventional DSA and 3-D-rotational angiography) in a consecutive series of different neurovascular pathologies in a newly constructed hybrid OR with robotic multi-axis flat-panel C-arm system (Artis Zeego). Furthermore a workflow-analysis evaluating the processes and expenditures of that kind of intraoperative neurovascular imaging is presented.

Method: First intraoperative imaging data were analysed and compared to intraoperative microscope based ICG. Furthermore a workflow analysis based on video recordings of the operations was performed, highlighting the key procedural steps and efforts.

Results: The series comprises 31 patients with 36 intracranial aneurysms of the anterior circulation: AcomA (n=8, n=4 previously coiled, MCA (n=19, n=3 previously coiled, ACI (n=9), 14 patients with AVMs and 2 DAVFs. Intraoperative angio was feasible in all cases except one (technical failure of the Zeego system). There were one (2,2%) adverse angio-related event (thrombembolic distal MCA (M4) left), no postoperative infections. Residual aneurysm not detected in ICG was found in 2 patients (5,6%) with consecutive clip repositioning (1 ACM previously coiled, 1 supraophthalmic ACI with inferior dome projection). Complete resection of AVMs could be confirmed in all cases. Workflow analysis demonstrated overall prolongation of OR-time of 52 minutes (preparation, angio, postprocessing) and a significant learning curve.

Conclusions: Despite its invasive nature intraoperative angiography seems feasible and safe. It revealed decisive information that could not be obtained by other means (ICG, Doppler) in 2 aneurysm cases. Especially in advanced arteriosclerotic disease indication for intraoperative intra-arterial angio should be carefully assessed. Preliminary results indicate that intra-venous rotational angiography might become a safe alternative in those patients.