From intraoperative angiography to advanced intraoperative imaging: the geneva experience

We aimed at the integration of recent flat panel technology in a joint interventional suite for neurosurgeons and neuroradiologists.

A Flat Panel system, allowing for intraoperative performance of 2D and 3D DSA, for automated segmentation of vascular structures, and for performance of computed tomography, was connected with a surgical microscope and neuronavigation. All surgical and neurointerventional cases were monitored and stored in a prospective data base.

N=99 patients were treated neurosurgically: N=63 aneurysm clippings in n=51 patients; n=12 resections of arteriovenous malformations (AVM); n=6 clippings/excisions of dural AV fistulae (dAVF); n=3 EC-IC bypass procedures; n=10 resections of skull base tumours; n=17 spine procedures. All patients had intraoperative imaging for angiographic control and/or for anatomical allocation. Intraoperative 3D-rotational angiography was performed n=54 times in n=42 patients in < 15 min each, with repositioning of aneurysm clips in n=9 patients.

This hybrid neuro-interventional suite opens a new avenue for intraoperative imaging by the provision of highly resoluted angiographic or CT images, which may be co-registered with a navigation system. In addition, the workflow in treatment of aneurysmal SAH can be improved, as all diagnostic and therapeutic measures can be taken without having to move the patient to other facilities.