Usefulness of Dual Volume Reconstruction of Three- dimensional Rotational Angiography in the Surgical Treatment of Spinal Vascular Malformations: Assessment of Image Similarity Between Angiography and Microscopy

Abstract

AIM: To describe and demonstrate the close analogy between dual volume reconstruction images derived using three-dimensional digital subtraction angiography (3D-DSA) and surgical microscopic images. MATERIAL and METHODS: From 2013 to 2018, 12 patients with spinal vascular malformation (SVM) underwent preoperative 3D-DSA with dual volume reconstruction followed by surgery for the SVM without prior endovascular treatment. Two spinal neurosurgeons involved in each operation were surveyed regarding the similarity between the dual volume images of 3D-DSA and the surgical microscopic images with respect to the following four aspects: (1) relationship between bony structures and the entry artery going to the feeder; (2) feeding artery; (3) shunting point or nidus location; and (4) draining vein. RESULTS: The patients were diagnosed with spinal dural arteriovenous fistulas (n=8) and spinal arteriovenous malformations (n=4). Two, six, and four lesions showed cervical, thoracic, and lumbar area distribution, respectively. All operations were successful and without complications. The correspondence between dual volume images and intraoperative microscopic images, with respect to bony structure and entry artery, showed perfect reliability (K=1.000; p=0.000) and a high level of similarity in all cases. With respect to the feeding artery, shunt point/nidus location, and draining vein, there was substantial reliability between the operator and the observer (K=0.750; p=0.045). CONCLUSION: Images obtained using the dual volume reconstruction technique of the 3D-DSA exhibit a reliable similarity to real microscopic images and are useful in the surgical treatment of SVMs with respect to surgical planning, targeting, and orientation.