Carotid artery visualization during anterior skull base surgery: a novel protocol for neuronavigation

Area of Science:

• Neurosurgery
• Medical Imaging
• Vascular Anatomy

Background:

• Accurate vascular anatomy of the anterior skull base is crucial for surgical success.
• Conventional neuronavigation uses MRI for soft tissues and CT for bone/vasculature.
• Limitations exist in visualizing carotid arteries with standard CT angiography.

Purpose of the Study:

• To describe a novel imaging protocol integrating MR angiography (MRA) into surgical neuronavigation.
• To enhance visualization of carotid arteries in anterior skull base surgery.
• To present Canadian and Austrian experiences with this protocol.

Main Methods:

• Utilized a pre-operative protocol combining T1-weighted MRI for soft tissues, CT for bone, and 3D time-of-flight MRA for carotid arteries.
• Imported imaging series into the Medtronic StealthStation((R)) TREON((R)) Treatment Guidance System.
• Allowed intra-operative viewing of individual or layered composite images (MRI, CT, MRA).

Main Results:

• The protocol provides detailed visualization of soft tissue, tumor, vascular, and bony anatomy.
• Eliminates the need for contrast CT, avoiding potential nephrotoxicity.
• Offers superior visualization of the carotid system compared to CT angiography.

Conclusions:

• This integrated imaging protocol enhances surgical navigation for anterior skull base procedures.
• It offers superior carotid artery visualization, crucial for endoscopic transsphenoidal surgeries.
• The protocol is routinely used, demonstrating its clinical utility and advantages.