Journal article
Amended Intraoperative Neuronavigation: Three-Dimensional Vascular Roadmapping with Selective Rotational Digital Subtraction Angiography.
- Fierstra J Department of Neurosurgery Aarau, Switzerland; Department of Neurosurgery, Clinical Neuroscience Center University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address: jorn.fierstra@usz.ch.
- Anon J Division of Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland.
- Mendelowitsch I Department of Neurosurgery Aarau, Switzerland.
- Fandino J Department of Neurosurgery Aarau, Switzerland.
- Diepers M Division of Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland.
- Remonda L Division of Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland.
- Marbacher S Department of Neurosurgery Aarau, Switzerland.
- 2019-12-22
Published in:
- World neurosurgery. - 2020
Cerebrovascular neuronavigation
Intraoperative selective rotational digital subtraction angiography (3D-iDSA)
Angiography, Digital Subtraction
Feasibility Studies
Humans
Imaging, Three-Dimensional
Intracranial Aneurysm
Microsurgery
Middle Cerebral Artery
Neuronavigation
Neurosurgical Procedures
Tomography, X-Ray Computed
Vascular Surgical Procedures
English
BACKGROUND
Accuracy of intraoperative cerebrovascular neuronavigation is difficult to maintain because of the ongoing need for brain shift correction. By including 3-dimensional rotational intraoperative digital subtraction angiography (3D-iDSA), the intraoperative cerebrovascular neuronavigation can be updated and upgraded throughout the microneurosurgical procedure. The aim of this technical note is to demonstrate the feasibility and advantage of updating and upgrading the accuracy of targeted cerebrovascular neuronavigation with an intraoperative 3D-DSA dataset.
METHODS
A preoperative diagnostic selective 3D-DSA was registered with the neuronavigation software, followed by the automated segmentation of the vascular object of interest (an aneurysm in this case). After acquiring additional 3D-iDSA volumes, these steps were repeated, thereby updating the cerebrovascular roadmap and neuronavigation accuracy (i.e., brain shift correction).
RESULTS
This technique was applied successfully in a patient who underwent elective microneurosurgical clipping of a right-sided middle cerebral artery (MCA) bifurcation aneurysm in a hybrid neurosurgical operating setting. After clipping of the MCA aneurysm, a selective 3D iDSA was performed that was then used to update the projection and accuracy of the initial 3D neurovascular object of interest (i.e., the aneurysm). In this revised rotational view, the projection refined the target segments of the clipped MCA aneurysm, the accuracy of clipping, and brain shift correction.
CONCLUSIONS
3D-iDSA vascular segmentations can update und upgrade the intraoperative neurovascular roadmap by thereby enhancing accuracy of cerebrovascular neuronavigation, as well as correcting brain shift. This technique is feasible within the hybrid operation room. Evaluation in larger series is required to support these findings.
Accuracy of intraoperative cerebrovascular neuronavigation is difficult to maintain because of the ongoing need for brain shift correction. By including 3-dimensional rotational intraoperative digital subtraction angiography (3D-iDSA), the intraoperative cerebrovascular neuronavigation can be updated and upgraded throughout the microneurosurgical procedure. The aim of this technical note is to demonstrate the feasibility and advantage of updating and upgrading the accuracy of targeted cerebrovascular neuronavigation with an intraoperative 3D-DSA dataset.
METHODS
A preoperative diagnostic selective 3D-DSA was registered with the neuronavigation software, followed by the automated segmentation of the vascular object of interest (an aneurysm in this case). After acquiring additional 3D-iDSA volumes, these steps were repeated, thereby updating the cerebrovascular roadmap and neuronavigation accuracy (i.e., brain shift correction).
RESULTS
This technique was applied successfully in a patient who underwent elective microneurosurgical clipping of a right-sided middle cerebral artery (MCA) bifurcation aneurysm in a hybrid neurosurgical operating setting. After clipping of the MCA aneurysm, a selective 3D iDSA was performed that was then used to update the projection and accuracy of the initial 3D neurovascular object of interest (i.e., the aneurysm). In this revised rotational view, the projection refined the target segments of the clipped MCA aneurysm, the accuracy of clipping, and brain shift correction.
CONCLUSIONS
3D-iDSA vascular segmentations can update und upgrade the intraoperative neurovascular roadmap by thereby enhancing accuracy of cerebrovascular neuronavigation, as well as correcting brain shift. This technique is feasible within the hybrid operation room. Evaluation in larger series is required to support these findings.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.wneu.2019.12.055
- PMID 31863893
- Persistent URL
- https://sonar.ch/global/documents/47650
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