gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Vascular neurosurgery and intraoperative CT: First experiences of combined intraoperative CT-angiography, CT-guided neuronavigation, and CT-perfusion imaging

Vaskuläre Neurochirurgie und intraoperatives CT: Erste Erfahrungen mit der kombinierten intraoperativen Bildgebung aus CT-Angiographie, CT-gestützte Navigation und CT-Perfusion

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  • corresponding author W. Rachinger - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • S. Zausinger - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • D. Morhard - Institut für Klinische Radiologie, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • T. Heigl - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • J. C. Tonn - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • C. Schichor - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocDI.01.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc143.shtml

Published: May 30, 2008

© 2008 Rachinger 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: A prospective series of patients was analyzed, who were operated on aneurysms or arteriovenous malformations. For the first time, practicability and usefulness of intraoperative CT-navigation, CT-angiography and intraoperative CT-perfusion imaging were evaluated.

Methods: The patient is positioned on a radiolucent operating table (Jupiter, Trumpf) that fits within the bore of the gantry. A sliding gantry 24 detector row CT (Somatom Open, Siemens) was used for image acquisition. During image acquisition the gantry moves over the patient. For cranial surgery, a carbon made radiolucent head clamp was combined with radiolucent pins for fixation of the skull. High resolution data of CT-angiography were imported to a frameless infrared-based neuronavigation station (Vector Vision Compact, BrainLAB). Data of CT-Angiography of three patients were used for intraoperative neuronavigation, control of aneurysm obliteration or resection control after AVM-surgery. Postprocedural intraoperative CT-perfusion imaging was obtained.

Results: The procedure of image acquisition was rapid and easy to perform without restricting access to the patient. Following a specific work flow interruption of surgery for scanning can be limited to 10-12 minutes. Update of neuronavigational data was achieved successfully as controlled by anatomical landmarks. All aneurysms suspected from conventional angiography could be identified by intraoperative CT-angiography – therefore, CT-angiographic data for neuronavigation were especially useful in tracking small, distal aneurysms. Temporary clipping of small, feeding vessels did not result in measurable perfusion deficits intraoperatively, which was approved by missing clinical impairment postoperatively in all cases.

Conclusions: CT-angiographic data, obtained by pre- or intraoperative CT-imaging, can be used for navigation-guided planning of the approach. In the same setting, intraoperative CT image acquisition allows data updating after dural opening. The completeness of aneurysm obliteration can be controlled in larger aneurysms, whereas further studies are needed for accuracy estimation. CT perfusion imaging can be obtained intraoperatively and offers the opportunity of perfusion control after temporary or permanent clipping procedures.