How Reliable Is the Intraoperative Computed Tomography Angiography in Assessing Complete Surgical Resection of Cerebral Arteriovenous Malformations?

2021 ◽  
Author(s):  
Fahad Saud Alotaibi ◽  
Sondous Raid Ntyl ◽  
Tafla Saleh Almuhaini ◽  
Sarah Bin Abdulqader ◽  
Naif M Alotaibi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Resection ◽  
Computed Tomography Angiography ◽  
Operative Time ◽  
Standard Test ◽  
Surgical Results ◽  
Intraoperative Computed Tomography ◽  
Complete Surgical Resection ◽  
Safety And Reliability ◽  
Microsurgical Resection

Abstract BACKGROUND Digital subtraction angiography (DSA) is still considered the gold standard test to evaluate arteriovenous malformation's (AVM) residual after microsurgical resection. OBJECTIVE To evaluate the safety and reliability of intraoperative computed tomography angiography (iCTA) as an immediate method of evaluating the surgical results of AVM resection. METHODS We performed a retrospective review for all cases of cerebral AVMs at our institute from January 2015 to April 2020 who underwent surgical resection of cerebral AVM and had iCTA. All included patients underwent a postoperative DSA, and the results were compared with iCTA. RESULTS Twenty-eight cases were included. All cases showed complete resection (100%) in the iCTA, and the results were consistent with the postoperative DSA results. The sensitivity of iCTA was 100%. The added operative time ranged from 25 to 30 min. There were no complications related to the use of iCTA. CONCLUSION Intraoperative assessment of AVMs surgical results with an iCTA is safe and reliable. The sensitivity of iCTA following AVM resection merits further investigations.

Enthesopathy of the Bicipital Tuberosity of the Radius Treated Under Intraoperative Computed Tomography

2021 ◽  
Author(s):  
Ryosuke Ikeguchi ◽  
Takashi Noguchi ◽  
Maki Ando ◽  
Koichi Yoshimoto ◽  
Diachi Sakamoto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Surgical Resection ◽  
Tendon Rupture ◽  
Computed Tomography Scan ◽  
Forearm Rotation ◽  
Elbow Pain ◽  
Intraoperative Computed Tomography ◽  
Tomography Scan ◽  
Bicipital Tuberosity

Abstract There is no report of the application of intraoperative computed tomography to the extremities, and its usefulness is not mentioned. We present a case of a patient with the elbow pain and loss of the forearm rotation due to the prominent bicipital tuberosity of the radius, which was diagnosed as enthesopathy. Surgical treatment to excise the prominent part of the bicipital tuberosity of the radius was recommended. However, it is difficult to perform the appropriate excision of the abnormal prominent part because of complications such as bicipital tendon rupture. The patient was successfully treated by surgical resection under the control of intraoperative computed tomography. Intraoperative computed tomography scan is a useful tool to assess the remaining volume of the abnormal bones.

Preoperative Computed Tomography Angiography for ALT Flaps Optimizes Design and Reduces Operative Time

2021 ◽  
Author(s):  
Christopher M. Schneider ◽  
Patrick A. Palines ◽  
Daniel J. Womac ◽  
Charles T. Tuggle ◽  
Hugo St Hilaire ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Operative Time ◽  
Donor Site ◽  
Vascular Anatomy ◽  
Complication Rates ◽  
Anterolateral Thigh ◽  
Extremity Reconstruction ◽  
Alt Flap ◽  
Selection Of

Abstract Background Computed tomography angiography (CTA) has been widely used for perforator mapping in abdominal-based reconstruction, but it is less widespread in the anterolateral thigh (ALT) flap. However, CTA may be quite useful for ALT planning, as this flap has demonstrated substantial variability in intrapatient bilateral vascular anatomy. This study investigated whether standard use of preoperative CTA resulted in selection of the donor extremity with preferential perforator anatomy, and whether this affected operative time and postoperative outcomes. Methods A retrospective review of 105 patients who underwent proposed ALT flap reconstruction was performed. Seventy-nine patients received bilateral lower extremity CTAs, which were evaluated for dominant perforator anatomy (septocutaneous, musculoseptocutaneous, or musculocutaneous). Donor extremity selection was noted, and predicted perforator anatomy was compared with that encountered intraoperatively. Results Among the 73 patients who received bilateral imaging and ultimately received an ALT, congruent findings between imaging and surgical exploration were observed in 51 (69.8%) patients. Thirty (37.9%) patients had asymmetric perforator anatomy between their bilateral extremities on imaging. Among these, the leg with optimal perforator anatomy was selected in 70% of cases. There were no significant reductions among postoperative complication rates, but selection of the donor site with preferential anatomy was associated with a decrease in operative time (p = 0.049) among patients undergoing extremity reconstruction. Conclusion CTA is a useful tool for optimizing donor site selection for ALT flaps and reducing operative time. We believe that standard use of preoperative CTA in ALTs warrants further consideration.

Intraoperative Simulation: Team Training for Resuscitation While Using Intraoperative Computed Tomography: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Jacob L Goldberg ◽  
Maria Bustillo ◽  
Jaroslav K Usenko ◽  
Philip Kuo ◽  
Sertac Kirnaz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Operative Time ◽  
Human Subjects ◽  
Positive Outcome ◽  
Spontaneous Circulation ◽  
Neurological Sequelae ◽  
Intraoperative Computed Tomography ◽  
Head Fixation ◽  
Emergency Personnel ◽  
Team Functioning

Abstract Spine surgeons increasingly use intraoperative computed tomography (iCT) to facilitate surgery. iCT has several advantages, including the ability to decrease radiation exposure, improve surgical accuracy, and decrease operative time.1-3 However, the large footprint of the equipment can impede fast patient access in the event of an emergency resuscitation. This challenge is compounded when the patient is prone with rigid head fixation. To achieve fast, high-quality resuscitation, a large team must overcome numerous challenges. Cohesive team functioning under these circumstances requires planning, practice, and refinement.4  As a result of our simulation sessions, we have made several changes to the setup of our iCT cases. The following equipment is now routinely used: extralong tubing between the anesthesia circuit and patient, portable vital monitor, additional intravenous access is obtained, and extension tubing is used with all lines. We have created educational diagrams to streamline 2 challenging processes: optimal bed placement (for supination) and removal of equipment from the operating room (OR) to accommodate an influx of emergency personnel and equipment.  Since the implementation of this protocol, 1 prone posterior cervical patient had intraoperative cardiac arrest. The protocol was followed. Return of spontaneous circulation was achieved within 5 min. The patient was discharged from the hospital with no neurological sequelae. During debriefing, stakeholders uniformly credited the simulated practice with this positive outcome.  Emergency planning is a multifaceted process that continually evolves. With a steady flux of personnel and equipment, ongoing practice is essential to ensure readiness. Here, we share the key elements of our twice-yearly simulation.  This simulation was performed on a training mannequin. This study did not involve human subjects. Any depictions of care rendered to nonidentifiable patients were standard (nonexperimental).

Intra-Arterial Intraoperative Computed Tomography Angiography Guided Navigation

2012 ◽  
Vol 71 ◽  
pp. ons240-ons252 ◽  
Author(s):  
Shaan M. Raza ◽  
Kyriakos Papadimitriou ◽  
Dheeraj Gandhi ◽  
Martin Radvany ◽  
Alessandro Olivi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Intraoperative Computed Tomography

Lipoblastoma – A Rare Benign Immature Adipocytic Neoplasm

2019 ◽  
Vol 1 ◽  
pp. 124-126
Author(s):  
Ankita Aggarwal ◽  
Ankur Goyal ◽  
Devasenathipathy Kandasamy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Early Diagnosis ◽  
Surgical Resection ◽  
Clinical Examination ◽  
Clinical History ◽  
Resonance Imaging ◽  
Complete Surgical Resection

Lipoblastoma is an uncommon fat-containing tumor of childhood having predilection for infants. Although it is benign in nature; even then, it can be locally aggressive. Clinical examination generally reveals painless, progressively increasing compressible swelling. Computed tomography or magnetic resonance imaging along with specific clinical history clinches the diagnosis. Imaging is of paramount importance as it helps in differentiating it from it’s close mimickers, which include lipoma, liposarcoma, rhabdomyosarcoma and teratoma. Early diagnosis with complete surgical resection is the management of choice.

Intraoperative Computed Tomography Angiography: A Novel Completion Imaging Modality for Carotid Endarterectomy

2017 ◽  
Vol 13 (6) ◽  
pp. 739-745 ◽  
Author(s):  
Anish N Sen ◽  
Jared Fridley ◽  
Sherly Sebastian ◽  
Edward A M Duckworth
Keyword(s):  
Computed Tomography ◽  
Carotid Endarterectomy ◽  
Computed Tomography Angiography ◽  
Medical Records ◽  
Imaging Modality ◽  
Neurological Complication ◽  
Internal Carotid Artery Stenosis ◽  
Intraoperative Computed Tomography ◽  
Patch Angioplasty ◽  
Significant Difference

Abstract BACKGROUND Intraoperative computed tomography angiography (ICTA) is a novel completion imaging modality for carotid endarterectomy (CEA). No studies exist in the literature describing ICTA use in CEA. OBJECTIVE To evaluate the feasibility and efficacy of ICTA as a method of immediately evaluating the technical results of CEA. METHODS Twenty-three consecutive CEAs were performed by a single neurosurgeon over an 8-month period. Of this series, 12 utilized ICTA for completion imaging, 10 utilized duplex ultrasonography (US), and 1 utilized no intraoperative completion imaging. Electronic medical records were reviewed to assess demographics, CTA results, US results, and need for revisions. RESULTS Patients included 13 men (62%) and 8 women (38%). All patients had symptomatic internal carotid artery stenosis. Polytetrafluoroethylene (PTFE) patch angioplasty was used in 16 cases (70%). Average operative times were comparable between cases that utilized CTA and US, 180 and 175 min, respectively. Major technical defects were identified in one of the 12 cases utilizing ICTA and none of the 10 cases utilizing intraoperative US. The technical defect was revised without subsequent neurological complication. One patient had a postoperative intracerebral hemorrhage requiring surgical evacuation. Fifteen patients were followed for up to 3 months with no postoperative stroke or transient ischemic attacks. CONCLUSION ICTA is a potentially safe and effective completion imaging modality compared to traditional alternatives, enabling the identification of technical deficits intraoperatively. While no statistically significant difference in operative times were noted between intraoperative CTA and US use, numerous steps must be taken to maximize the efficiency of ICTA.

Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Krohn ◽  
Gebauer ◽  
Hübler ◽  
Beck
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Intestinal Ischemia ◽  
Clinical Presentation ◽  
Lower Limbs ◽  
Upper Body ◽  
Descending Aorta ◽  
Before And After ◽  
Blood Pressures

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.

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