Three-dimensional rotational angiography guidance for aneurysm surgery

The aim of this study was to investigate the feasibility of integrating three-dimensional rotational angiography (3D-RA) data into a surgical navigation system and to assess its accuracy and potential clinical benefit.

The study cohort consisted of 16 patients with 16 intracranial aneurysms who had been scheduled for routine or emergency surgery. Rotational angiography data were exported using a virtual reality modeling language file format and imported into the BrainLAB VectorVision2 image-guided surgery equipment. During 3D-RA the position of the head was measured using a special headframe. The authors also determined the accuracy of 3D-RA image guidance and the clinical benefit as judged by the surgeon, including, for example, early identification of branching vessels and the aneurysm. There was good correspondence between the 3D-RA-based navigation data and the intraoperative vascular anatomy in all cases, with a maximum error of 9 degrees of angulation and 9 degrees of rotation. In eight cases, the surgeon determined that the 3D-RA image guidance facilitated the surgical procedure by predicting the location of the aneurysm or the origin of a branching artery that had been covered by brain tissue and blood clots.

The integration of 3D-RA into surgical navigation systems is feasible, but it currently requires a new perspective-registration technique. The intraoperative 3D view provides useful information about the vascular anatomy and may improve the quality of aneurysm surgery in selected cases.