Three-dimensional magnetic resonance angiography in the planning of aneurysm surgery

Standard planning for intracranial aneurysm surgery relies on the surgeon's intellectual reconstruction of the three-dimensional (3D) surgical field on the basis of a two-dimensional (2D) imaging modality, biplanar cerebral angiography. This method is relatively imprecise, and it relies on previous experience for optimal results. We describe a stereotactic magnetic resonance angiographic (MRA)-guided method based on computer segmentation techniques for the planning of aneurysm surgery that has the potential of bringing a 3D perspective to the lesion. The method has been evaluated retrospectively on 20 surgical patients in whom the aneurysm orientation and relationship to parent vessels were shown to match presurgical 3D stereotactic display. When it is adapted to frameless interactive surgical navigation, this method may become a useful adjunct in the surgical obliteration of these life-threatening lesions.