Transfemoral Approach for Intraoperative Angiography in the Prone or Three-quarter Prone Position : A Revisited Protocol for Intracranial Arteriovenous Malformation and Fistula Surgery.

摘要: Among the different arterial accesses, femoral access is main approach for intraoperative angiography (IOA) performed in a prone position. Without a standardized protocol, however, application of prone IOAs intracranial arteriovenous malformation (AVM) or fistula (AVF) surgery remains limited by its procedural complexity. This study describes detailed protocol IOA through a transfemoral and highlights several refinements preparing this procedure. retrospectively reviewed high cervical AVM/AVF surgical cases which both resection were three-quarter Extended sheath approaches radiolucent head clamps used all cases. An aneurysm clip, serving as a localization landmark IOA, was routinely placed within field. The imaging, clinical impact complications related to procedure recorded. A total six AVM three AVF cases, operated on (n = 7) (n = 2) positions, included. Multiple vessel injections required 66.7% successfully every intended vessel. All images adequate interpretation, except two non-radiolucent component clamp obscured region interest lateral views. Incomplete occlusion identified patients, clip provided precise guidance localizing residual nidus. Final confirmed complete lesion removal there no IOA-related complications. Three key steps setting-up are proposed: (1) utilize an extended approach, (2) establish with (3) avoid possible image interference from clamp.