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

Zhikui Wei, Tomas Garzon-Muvdi, Wuyang Yang, Justin M. Caplan, Martin G. Radvany, Geoffrey P. Colby, Alexander L. Coon, Rafael J. Tamargo, Judy Huang

Research output: Contribution to journalArticle

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)98-102
Number of pages5
JournalInterdisciplinary Neurosurgery: Advanced Techniques and Case Management
Volume2
Issue number2
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

Keywords

  • C-arm angiography
  • Cerebrovascular imaging
  • Computed tomography angiogram
  • Digital subtraction angiography
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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