Intraoperative angiography for neurovascular disease in the prone or three-quarter prone position.
BACKGROUND
Intraoperative angiography for neurovascular disease has gained wide acceptance as a useful tool. There are few published cases of intraoperative angiography performed in the prone or three-quarter prone position, and the transradial approach has not previously been described for this situation.


METHODS
We retrospectively reviewed our last 177 consecutive cases of intraoperative angiography performed for neurovascular disease. Of these cases, 21 were performed in the prone or three-quarter prone position. Two different approaches were used: (1) a previously described extended femoral sheath approach (13 cases) and (2) a newly described transradial approach (8 cases).


RESULTS
All 21 intraoperative angiograms were successfully completed in the prone or three-quarter prone position. This enabled us to make additional surgical adjustments when necessary or to conclude the operation. One complication, a dissection of the brachial artery, occurred during one intraoperative angiographic procedure.


CONCLUSIONS
Intraoperative angiography can be performed in the prone or three-quarter prone position with good efficacy and safety. The transfemoral route has the advantage of familiarity but has disadvantages of poor sterility at access site, possible kinking or thrombosis of the sheath, and possible skin injury while resting on the tubing during long procedures. The transradial route has advantages of continuous access to the entry site throughout the surgical procedure and ease of catheterization of vertebral arteries for occipital and suboccipital lesions. However, the transradial route has the disadvantage of working from an unfamiliar approach, especially for spinal arteriovenous malformations.
Lang
Shih-Shan
SS
University of Florida, Gainesville, FL 32610, USA.
Eskioglu
Eric
E
A Mericle
Robert
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography; D003399:Craniotomy; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D007432:Intraoperative Period; D007796:Laminectomy; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D016684:Prone Position / Q000502:physiology*; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery