Image-guided resection of embolized cerebral arteriovenous malformations based on catheter-based angiography.

OBJECTIVE: We introduce a technique that enables the use of catheter angiography during image-guided surgery for the resection of previously embolized arteriovenous malformations. METHODS: We used models to test the possibility of matching specific anatomic points 1:1 and the accuracy of merging catheter-based 3-dimensional angiography with standard computed tomographic angiography. RESULTS: After obtaining excellent accuracy matching the 2 modalities, we merged both studies into the image-guidance platform. After embolizing a patient's arteriovenous malformation with Onyx, we successfully used the merged study to navigate during surgical resection of the lesion. No complications resulted from this technique, which increases contrast by only 15 cm 3 and radiation exposure by 4 seconds. CONCLUSION: Catheter-based angiography can be used during image guidance to reduce the artifact from metal particles after embolization. Excellent accuracy was obtained in merging 3-dimensional angiography with computed tomographic angiography. Further studies are needed to evaluate catheter-based 3-dimensional angiography as a single method for navigation during neurovascular surgery.