Introduction: AVMs are cerebrovascular lesions that consist of a tangle of abnormal blood vessels. Three morphologic features are typical of these lesions: feeding arteries, draining veins, and a dysplastic vascular nidus. Conventional cerebral angiography is the gold standard to evaluate any residual after surgical resection. ,However, it is costly, invasive and carries risks . So we proposed that an intraoperative CTA after resection of AVM can be a good modality to confirm a complete resection of the AVM and decrease the need for catheter cerebral angiography post operatively.
Methods: This is a retrospective study, investigating all cases of surgically resected AVM at NNI,KFMC, Saudi Arabia, from 2005 to 2017, who underwent an intraoperative CTA. Intraoperative CTA was used in combination with neuronavigation software in all those cases to aid localization and ensure complete AVM resection. Postop cerebral angiogram was done in all included patients and the results were compared to the intra op CTA.
Results: 15 cases underwent an intraoperative CTA, 10 of them have met all the inclusion criteria of our study.In 8 cases (80%), the intraoperative CTA showed complete resection and in 1 case the CTA showed incomplete obliteration of the AVM , in all these 9 cases the results were consistent with the post-operative DSA results. but in 1 case the intraoperative CTA showed complete removal of the AVM where the follow up DSA showed a near complete removal due to blushing in the surgical cavity site. the CTA sensitivity in our study was 90.9 %.
Conclusions: Intraoperative assessment of the surgical results with an intra op CTA prior to skin closure offers the neurosurgeon the opportunity to resect the AVM completely, and decrease the need for a second operation. With improving quality of intraoperative CTA in the future, the need for post operative angiogram will likely be eliminated
Patient Care: Intraoperative assessment of the surgical results with an intra op CTA prior to skin closure offers the neurosurgeon the opportunity to resect the AVM completely, and decrease the need for a second operation.
Learning Objectives: By the conclusion of this session, participants should be able to understand that
1- Complete resection of the AVM can eliminate the risk of future bleeding
2- Intra operative CTA can aid in the complete surgical resection of the AVM and confirming it during the operation and decreases the need for re dos or second surgery in the future for residuals
3- Using the intra operative CTA has numerous advantages, including less invasive in comparison to DSA where you need a specialized neurointerventionist at each case which is usually difficult and non-practical ,
4- CTA has less radiation exposure in compare to DSA
5- doing the CTA intraop takes less time and much faster than intraoperative DSA or MRI .