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Abstract
Introduction Micro Dynamic computed tomography (micro DynaCT) is an advanced intraoperative flat panel imaging technique that provides real-time high-resolution microvascular imaging of submillimeter intracranial perforator vessels. MicroDynaCT facilitates delineation of critical neurovascular structures through its ability to depict contrast-enhanced vasculature with superior spatial resolution compared to any other flat panel imaging modality. In this study, we aimed to evaluate the clinical feasibility, accuracy, and utility of employing an intraoperative micro DynaCT imaging protocol in a hybrid operating room during microsurgical clipping for various neurovascular pathologies.
Method We retrospectively reviewed 18 patients who underwent micro DynaCT during arteriovenous malformation resection, aneurysm clipping, and dural arteriovenous fistula treatment at the Hospital of the University of Pennsylvania between July 2022 and March 2024. Angiography was performed using the biplane angiographic suite (Artis Icono; Siemens) and reconstructions were performed using DynaCT software. For each scan, volumetric data was acquired over 14 seconds in a single rotation of the C-arm mounted flat-panel detector cone-beam CT system. A 50% contrast dilution mixture (isovue-300) was employed for 34cc volume injected at 2cc/sec (Nemoto Press DuoElite). Ability to identify and measure recurrent artery of Huebner, anterior choroidal artery, lateral lenticulostriate perforators was assessed by 3 separate neuroradiologists on 0.5 mm multiplanar reconstructed datasets. Demographic information and clinical metrics like contrast volume, access site, and vessel studied were collected. Descriptive and statistical analysis was performed.
Results Among the 18 patients reviewed, the average age was 51.5 years, with 50% (9/18) of the patients being male. 77.8% (14/18) of the procedures were aneurysm clippings, 11.1% (2/18) were arteriovenous malformation resections, and 11.1% (2/18) were dural arteriovenous fistula treatments. The average contrast volume used was 52.14 mL. The most common access site was the right radial artery (10/18) The vessels studied included the carotid arteries and vertebral arteries.Each of the evaluating neuroradiologists were able to consistently spatially resolve the 3 perforator vessels in more than 80% (15/18) of the cases.
Conclusion This retrospective analysis demonstrates technical feasibility of leveraging intraoperative microDynaCT to perform reproducible perforator vessel mapping during microsurgical clipping. This imaging modality provided superior spatial resolution despite presence of intraoperative surgical equipment and absence of bone flap with minimal artifact. This intraoperative imaging technique has the potential to reduce morbidity from perforator compromise during microsurgery. Perforator occlusion with subcortical ischemia is often missed during intraoperative neurophysiologic monitoring and microDyna CT can provide a useful adjunct in this assessment.
Disclosures A. Gerlach: None. O. Gandhi: None. J. Gujral: None. E. Walker: None. O. Choudhri: 2; C; Balt, Microvention,Medtronic, Siemens, Q’apel, EO Solutions.