BACKGROUND A hybrid operating room(hybrid-OR)is a surgical space that combines a conventional operating room with advanced medical imaging devices.AIM To explore and summarize the technical features and effectiveness ...BACKGROUND A hybrid operating room(hybrid-OR)is a surgical space that combines a conventional operating room with advanced medical imaging devices.AIM To explore and summarize the technical features and effectiveness of the application of a hybrid-OR in dealing with spinal dural arteriovenous fistulas(SDAVFs).METHODS Eleven patients with SDAVFs were treated with the use of a hybrid-OR at the Department of Neurosurgery of our hospital between January 2015 and December 2018.The dual-marker localization technique was used in the hybrid-OR to locate the SDAVFs and skin incision,and the interoperative digital subtraction angiography(DSA)technique was used before and after microsurgical ligation of the fistulae in the hybrid-OR to verify the accuracy of obliteration.The patients were followed for an average of 2 years after the operation,and the preoperative American Spinal Cord Injury Association(ASIA)score and postoperative ASIA score at 6 mo after the operation were compared.RESULTS The location and skin incision of the SDAVFs were accurately obtained by using the dual-marker localization technique in the hybrid-OR in all patients,and there were no cases that required expansion of the range of the bone window in order to expose the lesions.Intraoperative error obliteration occurred and was identified in two patients by using the intraoperative DSA technique;therefore,the findings provided by the intraoperative DSA system significantly changed the surgical procedure in these two patients.With the assistance of the hybrid-OR,the feeding artery was correctly ligated in all cases,and the intraoperative error obliteration rate decreased from 18.2%(2/11)to 0%.All 11 patients were followed for an average of 2 years.The ASIA score at 6 mo after the operation was significantly improved compared with the preoperative ASIA score,and there were no patients with late recurrence during the follow-up.CONCLUSION Compared with intra-arterial embolization for the treatment of SDAVFs,hybrid-ORs can solve the problem of a higher incidence of initial failure and late recurrence.Compared with direct occlusion of SDAVFs in microsurgery,hybrid-ORs can take advantage of the intraoperative DSA system for locating the shunt and verifying the obliteration of fistulae in order to reduce the error obliteration rate.At this point,our experience suggests that the safety and ease of use make hybrid-ORs combined with microsurgery and intraoperative DSA systems an attractive modality for dealing with SDAVFs.展开更多
Spinal dural arteriovenous fistulas (SDAVF) account for about 70% of all spinal AV shunts. We re-port on a 56-year-old male patient with progressive neurological symptoms. Pre- and post-contrast MR imaging of the spin...Spinal dural arteriovenous fistulas (SDAVF) account for about 70% of all spinal AV shunts. We re-port on a 56-year-old male patient with progressive neurological symptoms. Pre- and post-contrast MR imaging of the spine, including contrast-enhanced MR angiography was done on a 1.5 T MR scanner. In addition a special (pre-contrast) 3D turbo-spin-echo sequence with variable flip angle evolution (SPACE) was performed providing a slice thickness of 0.9 mm. T2-weighted images showed extensive widened and tortuous vascular structures with typical flow voids intradurally due to dilated pial veins. The origin of the spinal dural arteriovenous fistula was found to be the radiculomeningeal artery at level D10/11 on the left side, visualized by the T2-weighted 3D SPACE sequence and CE MRA. After imaging the patient was referred to an interventional neuroradiology department for therapy. With the detailed information from MR imaging concerning the fistula level the interventional radiologist was able to find the fistula immediately and consequently treated it successfully by endovascular therapy. Interpreting the MR images of this obvious case of a SDAVF, SPACE sequence after post processing with 3D MPR software directly led to the location of the AV shunt at D10/11 on the left side, better than 3D contrast-enhanced MR angiography did. Therefore, SPACE can be a useful adjunct in further evaluation of spinal dural arteriovenous fistula and especially in defining fistula level.展开更多
Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG) videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs) . Methods In this retrospective analysis ...Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG) videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs) . Methods In this retrospective analysis we examined nine cases of dAVFs,diagnosed by complete spinal angiography,in which laminoplasty were performed through posterior approach. An operating microscope-integrated light展开更多
Spinal arteriography is an esoteric procedure that is seldom performed by peripheral interventionalists. This presentation is intended to outline some of the essential points that the interventionalist performing the ...Spinal arteriography is an esoteric procedure that is seldom performed by peripheral interventionalists. This presentation is intended to outline some of the essential points that the interventionalist performing the procedure should be aware of, especially about spinal dural arteriovenous fistulae (SDAVF).展开更多
基金the Tianjin Science and Technology Projects in Key Areas of Traditional Chinese Medicine,No.2018001.
文摘BACKGROUND A hybrid operating room(hybrid-OR)is a surgical space that combines a conventional operating room with advanced medical imaging devices.AIM To explore and summarize the technical features and effectiveness of the application of a hybrid-OR in dealing with spinal dural arteriovenous fistulas(SDAVFs).METHODS Eleven patients with SDAVFs were treated with the use of a hybrid-OR at the Department of Neurosurgery of our hospital between January 2015 and December 2018.The dual-marker localization technique was used in the hybrid-OR to locate the SDAVFs and skin incision,and the interoperative digital subtraction angiography(DSA)technique was used before and after microsurgical ligation of the fistulae in the hybrid-OR to verify the accuracy of obliteration.The patients were followed for an average of 2 years after the operation,and the preoperative American Spinal Cord Injury Association(ASIA)score and postoperative ASIA score at 6 mo after the operation were compared.RESULTS The location and skin incision of the SDAVFs were accurately obtained by using the dual-marker localization technique in the hybrid-OR in all patients,and there were no cases that required expansion of the range of the bone window in order to expose the lesions.Intraoperative error obliteration occurred and was identified in two patients by using the intraoperative DSA technique;therefore,the findings provided by the intraoperative DSA system significantly changed the surgical procedure in these two patients.With the assistance of the hybrid-OR,the feeding artery was correctly ligated in all cases,and the intraoperative error obliteration rate decreased from 18.2%(2/11)to 0%.All 11 patients were followed for an average of 2 years.The ASIA score at 6 mo after the operation was significantly improved compared with the preoperative ASIA score,and there were no patients with late recurrence during the follow-up.CONCLUSION Compared with intra-arterial embolization for the treatment of SDAVFs,hybrid-ORs can solve the problem of a higher incidence of initial failure and late recurrence.Compared with direct occlusion of SDAVFs in microsurgery,hybrid-ORs can take advantage of the intraoperative DSA system for locating the shunt and verifying the obliteration of fistulae in order to reduce the error obliteration rate.At this point,our experience suggests that the safety and ease of use make hybrid-ORs combined with microsurgery and intraoperative DSA systems an attractive modality for dealing with SDAVFs.
文摘Spinal dural arteriovenous fistulas (SDAVF) account for about 70% of all spinal AV shunts. We re-port on a 56-year-old male patient with progressive neurological symptoms. Pre- and post-contrast MR imaging of the spine, including contrast-enhanced MR angiography was done on a 1.5 T MR scanner. In addition a special (pre-contrast) 3D turbo-spin-echo sequence with variable flip angle evolution (SPACE) was performed providing a slice thickness of 0.9 mm. T2-weighted images showed extensive widened and tortuous vascular structures with typical flow voids intradurally due to dilated pial veins. The origin of the spinal dural arteriovenous fistula was found to be the radiculomeningeal artery at level D10/11 on the left side, visualized by the T2-weighted 3D SPACE sequence and CE MRA. After imaging the patient was referred to an interventional neuroradiology department for therapy. With the detailed information from MR imaging concerning the fistula level the interventional radiologist was able to find the fistula immediately and consequently treated it successfully by endovascular therapy. Interpreting the MR images of this obvious case of a SDAVF, SPACE sequence after post processing with 3D MPR software directly led to the location of the AV shunt at D10/11 on the left side, better than 3D contrast-enhanced MR angiography did. Therefore, SPACE can be a useful adjunct in further evaluation of spinal dural arteriovenous fistula and especially in defining fistula level.
文摘Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG) videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs) . Methods In this retrospective analysis we examined nine cases of dAVFs,diagnosed by complete spinal angiography,in which laminoplasty were performed through posterior approach. An operating microscope-integrated light
文摘Spinal arteriography is an esoteric procedure that is seldom performed by peripheral interventionalists. This presentation is intended to outline some of the essential points that the interventionalist performing the procedure should be aware of, especially about spinal dural arteriovenous fistulae (SDAVF).
