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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Surgical treatment of distal anterior cerebral artery aneurysms aided by electromagnetic navigation CT angiography

Meeting Abstract

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  • Elvis J. Hermann - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
  • Ioannis Petrakakis - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
  • Friedrich Götz - Institut für Neuroradiologie, Medizinische Hochschule Hannover, Hannover
  • Götz Lütjens - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
  • Josef Lang - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
  • Makoto Nakamura - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
  • Joachim K. Krauss - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.05.03

doi: 10.3205/14dgnc300, urn:nbn:de:0183-14dgnc3006

Published: May 13, 2014

© 2014 Hermann 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: The surgical treatment of distal anterior cerebral artery (DACA) aneurysms still presents a challenge for neurosurgeons because of their small size and their location in the depth of the narrow frontal interhemispheric fissure. While opto-electric navigation was shown to be useful in such conditions, there has been no experience with the newer method of EM guided neuronavigation. This study aimed to investigate feasibility, safety, accuracy and usefulness of EM navigation to aid clipping of DACA aneurysms.

Method: Eight patients (age between 2 and 68 years, mean age 49.8 years) with a DACA aneurysm underwent EM guided neuronavigated microsurgery for clipping of the aneurysm. Four patients had a subarachnoid hemorrhage and four patients had unruptured aneurysms. All patients underwent craniocervical 3D-CT angiography preoperatively. Intraoperative registration by surface matching was performed prior to head fixation in the Mayfield clamp in supine position. After planning the optimal approach and surgical trajectory avoiding opening of the frontal sinus and any damage to bridging veins, the head was fixed. Intraoperative screenshots were correlated with the microscopical view of the DACA aneurysms before clipping.

Results: EM guided neuronavigation using CT angiography for DACA aneurysms was technically feasible with ease. It enabled fast and accurate referencing of the patient and planning of a tailored craniotomy in all patients without opening of the frontal sinus. Additional time for setup of the EM navigation system was about 10-15 min. Intraoperative accuracy of the system was highly reliable except in one instance due to dislocation of the dynamic reference frame (DRF). There was a good correlation between the 3D-CT angiography based navigation data sets and the intraoperative vascular anatomy. In all patients bridging veins were spared and the parent vessels and aneurysms were approached promptly. The aid of EM neuronavigation was considered useful in all instances.

Conclusions: EM guided neuronavigation using CT angiography for surgery of DACA aneurysms is a straightforward and useful tool optimizing the surgical approach and the trajectory directly to the aneurysm minimizing additional damage to the surrounding tissue during preparation of the aneurysm and the parent vessel especially in patients with subarachnoid hemorrhage and brain swelling.