gms | German Medical Science

Objective: Intraoperative Angiography is a frequently used tool for cerebrovascular cases. 3D Ultrasound angiography has been introduced recently, but only by stand alone high end ultrasound machines. The aim of this study was to use 3D intraoperative power doppler acquisition and fuse it to the CT or MRI neuronavigation and achieve an intraoperative updated navigated 3D ultrasound angiography.

Methods: The new ultrasound system (IGsonic) is integrated into a neuronavigation system (VectorVision®2, BrainLAB, Germany). A precalibrated tracking array is attached to the probe and allows tracking the position of the ultrasound image plane. We have used intraoperative 3D power doppler ultrasound data acquisition for 13 patients for intracranial vascular objects. The acquisition time was 2 minutes each and calculation time was 60 seconds. The 3D angiographic ultrasound data was fused to the preoperative data via registration and the reference coordinate system.

Results: The system worked properly during all procedures. It displays a reconstruction view of the 3D power doppler ultrasound images (axial, sagittal, coronal), vessels or vascular lesions, in combination with the preoperatively-acquired neuronavigational data (CT or MRI).

Conclusions: Using intraoperative 3D power doppler ultrasound data to reconstruct and fuse it to the navigational data set leads to additional three-dimensional information about vascular structures. This is now possible with an one platform navigation system in a plug and play fashion. Although picture quality is still restricted, with further technical evolution, this additional intraoperative angiography could develop into a promising intraoperative imaging method without any interventional risks for the patient.