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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Utility of navigating intraoperative computed tomographic angiography in the surgical treatment of intracranial aneurysms via keyhole craniotomies

Meeting Abstract

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  • Kai-Michael Scheufler - Department of Neurosurgery, Klinik Hirslanden Zurich, Switzerland
  • Donatus Cyron - Department of Neurosurgery, Klinik Hirslanden Zurich, Switzerland
  • Hildegard Dohmen - Department of Neurosurgery, Klinik Hirslanden Zurich, Switzerland; Department of Neuropathology, University Hospital Zurich, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1580

doi: 10.3205/10dgnc055, urn:nbn:de:0183-10dgnc0559

Published: September 16, 2010

© 2010 Scheufler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: To assess the utility of integrating intraoperative computed tomographic angiography (iCTA) and neuronavigation in the surgical treatment of anterior and posterior cerebral circulation aneurysms via tailored keyhole approaches.

Methods: We prospectively analyzed the impact of navigating iCTA images on surgical access planning, clip selection and intraoperative assessment of aneurysm occlusion in 37 patients harboring a total of 42 anterior and posterior circulation aneurysms. iCTA navigation was employed in 19 patients, whereas the remainder was treated on the basis of rotational 3-dimensional digital subtraction angiographic (3D-DSA) imaging. Specifically, the incidence of surgical approach modification and clip replacement based on iCTA findings was recorded. The sensitivity and specificity of iCTA in delineating aneurysm and parent vessel morphology as well as detection of incomplete occlusion or presence of residual aneurysm necks was compared to intraoperative microsurgical and micro-dopplersonographic as well as postoperative 3D-DSA findings.

Results: Surgical access was modified in 8 of the 19 cases (42%) undergoing iCTA to facilitate parent vessel and aneurysm neck exposure as well as clip application based on 3D-renderings of iCTA used in the planning of image guided supraorbital and retromastoid keyhole approaches. The side of approach was switched in 3 patients (14%) treated for AComA aneurysms. The appropriate clip type and size could be predicted according to virtual anatomy in 64% of aneurysms. Persistent aneurysm filling or neck remnants, as well as parent artery stenosis (MCA branches off trifurcation, PICA) were detected in 4 patients (22%).

Conclusions: Navigated iCTA is useful to tailor surgical keyhole approaches to intracranial aneurysms based on individual neurovascular anatomy, including clip selection based on 3D-renderings of aneurysms and parent vessel anatomy. In turn, the potential avoidance of aperture clips increases the predictive value of iCTA in the intraoperative assessment of aneurysm occlusion and parent vessel compromise.