Utility of intraoperative diagnostic C-arm angiography for management of high grade subarachnoid hemorrhage

Abstract The accurate and efficient localization of underlying vascular lesions is crucial for prompt and definitive treatment of subarachnoid hemorrhage (SAH). To demonstrate the utility and feasibility of intraoperative C-arm angiography in cerebrovascular emergencies, we report five cases of high...

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Published in:Interdisciplinary neurosurgery : Advanced techniques and case management 2015-06, Vol.2 (2), p.98-102
Main Authors: Wei, Zhikui, Garzon-Muvdi, Tomas, Yang, Wuyang, Caplan, Justin M, Radvany, Martin G, Colby, Geoffrey P, Coon, Alexander L, Tamargo, Rafael J, Huang, Judy
Format: Article
Language:English
Subjects:
C-arm angiography
Cerebrovascular imaging
Computed tomography angiogram
Digital subtraction angiography
Medical Education
Neurosurgery
Subarachnoid hemorrhage
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Summary:Abstract The accurate and efficient localization of underlying vascular lesions is crucial for prompt and definitive treatment of subarachnoid hemorrhage (SAH). To demonstrate the utility and feasibility of intraoperative C-arm angiography in cerebrovascular emergencies, we report five cases of high grade SAH and/or intracerebral hemorrhage (ICH) where intraoperative diagnostic C-arm angiography was safely and effectively utilized. Initial evaluations of all patients included a non-contrast head CT scan, which was followed by urgent decompressive hemicraniectomy as a life-saving measure in the presence of markedly elevated intracranial pressure. Further diagnostic evaluations were performed intraoperatively using a multi-purpose C-arm angiography system. The C-arm angiography findings greatly aided the intraoperative planning and led to definitive treatments in four cases of SAH by elucidating the underlying neurovascular lesions. With this treatment strategy, two of the patients made moderately good recoveries from their SAH and/or ICH with a Glasgow outcome score (GOS) of 4. Three of the patients expired despite maximal therapy mostly due to unfavorable presenting grade. These results suggest that C-arm angiography is a reasonable diagnostic and surgical planning tool for selected patients with high grade diffuse SAH who require immediate decompression.
ISSN:2214-7519
2214-7519
DOI:10.1016/j.inat.2015.03.002