title: Intraoperative angiography reloaded: a new hybrid operating theater for combined endovascular and surgical treatment of cerebral arteriovenous malformations: a pilot study on 25 patients.
abstract: BACKGROUND
  Multimodality treatment suites for patients with cerebral arteriovenous malformations (AVM) have recently become available. This study was designed to evaluate feasibility, safety and impact on treatment of a new intraoperative flat-panel (FP) based integrated surgical and imaging suite for combined endovascular and surgical treatment of cerebral AVM.
  
  
  METHODS
  Twenty-five patients with AVMs to treat with combined endovascular and surgical interventions were prospectively enrolled in this consecutive case series. The hybrid suite allows combined endovascular and surgical approaches with intraoperative scanner-like imaging (XperCT®) and intraoperative 3D rotational angiography (3D-RA). The impact of intraoperative multimodal imaging on feasibility, workflow of combined interventions, surgery, and unexpected imaging findings were analyzed.
  
  
  RESULTS
  Twenty-five patients (mean age 38 ± 18.6 year) with a median Spetzler-Martin grade 2 AVM (range 1-4) underwent combined endovascular and surgical procedures. Sixteen patients presented with a ruptured AVM and nine with an unruptured AVM. In 16 % (n = 4) of cases, intraoperative imaging visualized AVM remnants ≤3 mm and allowed for completion of the resections in the same sessions. Complete resection was confirmed in all n = 16 patients who had follow-up angiography one year after surgery so far. All diagnostic and therapeutical steps, including angiographic control, were performed without having to move the patients
  
  
  CONCLUSIONS
  The hybrid neurointerventional suite was shown to be a safe and useful setup which allowed for unconstrained combined microsurgical and neuroradiological workflow. It reduces the need for extraoperative angiographic controls and subsequent potential surgical revisions a second time, as small AVM remnants can be detected with high security.
authors.affiliation: Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Kotowski
authors.forename: Asita
authors.initials: A
authors.lastname: Sarrafzadeh
authors.forename: Bawarjan
authors.initials: B
authors.lastname: Schatlo
authors.forename: Colette
authors.initials: C
authors.lastname: Boex
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Narata
authors.forename: Vitor Mendes
authors.initials: VM
authors.lastname: Pereira
authors.forename: Philippe
authors.initials: P
authors.lastname: Bijlenga
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000295:instrumentation* / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D010865:Pilot Projects; D016896:Treatment Outcome