Three-dimensional rotational angiography guidance for aneurysm surgery

Area of Science:

• Neurosurgery
• Medical Imaging
• Surgical Navigation

Background:

• Intracranial aneurysms pose significant surgical challenges.
• Accurate pre-operative and intra-operative visualization is crucial for successful aneurysm treatment.

Purpose of the Study:

• To evaluate the feasibility of incorporating three-dimensional rotational angiography (3D-RA) data into surgical navigation systems.
• To assess the accuracy and clinical utility of this integrated approach for aneurysm surgery.

Main Methods:

• 16 patients with intracranial aneurysms underwent surgery using a navigation system integrated with 3D-RA data.
• 3D-RA data was exported and imported into BrainLAB VectorVision2 image-guided surgery equipment.
• Accuracy was assessed by comparing navigation data with intraoperative vascular anatomy; clinical benefit was judged by the surgeon.

Main Results:

• Good correspondence was observed between 3D-RA navigation data and intraoperative vascular anatomy (max error: 9° angulation, 9° rotation).
• In 8 cases, 3D-RA image guidance facilitated surgery by predicting aneurysm or vessel locations obscured by tissue or clots.
• Early identification of branching vessels and the aneurysm was noted.

Conclusions:

• Integration of 3D-RA into surgical navigation systems is feasible, though a new perspective-registration technique is needed.
• Intraoperative 3D views offer valuable vascular anatomy information.
• This approach may enhance the quality of aneurysm surgery in select patient cases.