Image-guided microneurosurgical management of vascular lesions using navigated computed tomography angiography. An...

Image-guided neurosurgery has become a standard practice in the last few years, with more than 2000 surgical navigation stations installed worldwide. In the same time several reports have also demonstrated the efficacy and accuracy of computed tomography angiography (CTA) in assessing cerebral vascular pathologies. Therefore, the CTA data have recently been implemented into the different navigation systems available on the market, making this new technique widely applied. The objective of this paper is to discuss and evaluate the clinical usefulness of navigated CTA in planning and performing surgery of neurovascular lesions.

Raw images acquired from an helical CTA are automatically post-processed on an independent workstation by using a three-dimensional (3D) volume-rendering images engine and/or using thresholding and drawing tools.

The data obtained provide useful information in the preoperative stage by reconstructing the vascular tree with regard to lesion volume, aneurysm neck, dome projection, perforating vessels and their relationship with the lesion and the surrounding anatomy. Furthermore, it can help in the identification of an arteriovenous malformation (AVM) nidus and recognition of its feeding and draining vessels.

This fascinating technique can give some invaluable advantages on the management of cerebral vascular lesions and provides excellent information not always available on traditional digital subtraction angiography investigation. It has also proved to be very accurate, particularly regarding the correlation between the 3D volume-rendered CT angiography and the intraoperative findings.