Novel use of intraoperative cone-beam imaging with on-table angiography for excision of an occipitocervical tumour: A technical note and its feasibility
Su Z., Prezerakos GK., Sabah S., Rezajooi K.
Introduction: Intraoperative imaging and stereotactic navigation in spinal surgery to guide instrumentation placement and tumour resection is well documented. However, image depiction is restricted to high attenuation structures such as osseous tissue and metal objects. Vascular anatomy like major arteries or vascular neoplasm cannot be depicted. We reported angiographically enhancing intraoperative cone-beam imaging (O-arm) to facilitate resection of a craniocervical junction neoplasm that distorted the course of vertebral artery, and discussed the feasibility of this technique. Methods: We performed intraoperative angiography employing the O-arm for image acquisition, and applied the images in S7 Stealth Station to guide tumour resection in an occipitocervical osseous tumour in which the course of the vertebral artery was heavily distorted. Results: Intraoperative findings matched the 3D navigation images demonstrating the V3 and upper V2 segments of the vertebral artery in close proximity to the tumour. Complete en bloc tumour removal was achieved without injury to the adjacent vertebral artery. No intra- or postoperative complications occurred. Conclusion: It is feasible intraoperatively to acquire angiographically enhancing cone-beam imaging of spinal tumour in close proximity to the V3 and upper V2 segments of vertebral artery. It appears to facilitate safe tumour resection by mapping critical vascular structures in the surgical field that is initially occult to direct vision. Such novel use of technique warrants further validation.