Image-guided vascular neurosurgery based on three-dimensional rotational angiography. Technical note.

Area of Science:

• Neurosurgery
• Medical Imaging
• Vascular Neurology

Background:

• Three-dimensional rotational angiography offers detailed visualization of cerebral vasculature.
• Current limitations include a lack of external landmarks for patient-to-image registration, hindering neuronavigation.
• This study aimed to develop an alternative technique for 3D rotational angiography-guided vascular neurosurgery.

Observation:

• A novel technique was developed using navigated pointer and fiducial positions outside the image volume for registration.
• The technique was validated on a phantom and two patients with intracranial aneurysms.
• The neuronavigation system successfully provided 3D images of the vascular tree in the correct surgical orientation.

Findings:

• Patient-to-image registration was achieved using external fiducial points.
• The system demonstrated accurate 3D visualization of the cerebral vascular tree.
• Tissue shift was observable during surgery without altering the orientation of structures.

Implications:

• The findings demonstrate the feasibility of using 3D rotational angiography data for neuronavigation.
• This technique has the potential to improve precision in vascular neurosurgery.
• Further studies are needed to determine the clinical benefits of this navigation approach.