title: Simple technique for intraoperative angiographic localization of small vascular lesions.
abstract: BACKGROUND
  Precise surgical localization of small arteriovenous malformations (AVMs), arteriovenous fistulae (AVFs), and aneurysms located in the distal portions of the intracranial arteries can be difficult.
  
  
  OBJECTIVE
  We describe a simple and accurate intraoperative angiographic localization technique for small AVMs, AVFs, and distal aneurysms.
  
  
  METHODS
  All patients had routine preoperative diagnostic imaging and evaluations, including catheter angiography. Once anesthetized, the patients were prepared for intraoperative angiography following cannulation of the femoral artery. Craniometric landmarks were utilized to approximately localize the lesion. A wire in the shape of a square was placed over the proposed craniotomy site and an angiogram was performed. With use of real-time angiography, the wire localizer was manipulated until the small vascular lesion was visualized entirely within the wire frame, thus defining the extent of the required craniotomy and the surgical trajectory.
  
  
  RESULTS
  The wire localizer was used to target small vascular lesions in 9 cases of AVMs, 4 cases of distal middle cerebral artery aneurysms, and 1 case of a diploic AVF. In all 14 cases, the lesion was accurately localized intraoperatively without further image-guided techniques, and there was no change in the craniotomy. There were no intraoperative complications, and all patients had uneventful recoveries.
  
  
  CONCLUSIONS
  Intraoperative angiography with a simple wire localizer can effectively and accurately aid in the planning of surgery for a range of small and distal vascular lesions with virtually no added cost, minimal setup time, and limited potential for technical errors.
authors.affiliation: Division of Neurological Surgery, University of North Carolina Hospitals School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Anand V
authors.initials: AV
authors.lastname: Germanwala
authors.forename: Quoc-Anh
authors.initials: QA
authors.lastname: Thai
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pradilla
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Tamargo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000473:pathology; D002533:Cerebral Angiography / Q000295:instrumentation / Q000379:methods*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult