Image guided excision of a ruptured feeding artery ?pedicle aneurysm? associated with an arteriovenous malformation in a child: Case report

Image-guided microneurosurgical management of vascular lesions using navigated computed tomography angiography. an advanced IGS technology application

“…The optical definition and anatomical projection of the vascular lesion with this technique is also superior to that of DSA alone. Furthermore, the correlation of the 3D volume-rendering CT angiography with the intraoperative findings is excellent, as has already been discussed by one of the authors in a recently published paper (28) as well as by others (4)(5)(6)(7)11,12,15,17,25). With respect to the system's accuracy, it seems to be similar to that of the IGS system, although we do not yet have sufficient data to support a statistical appraisal.…”

“…Furthermore, for some types of lesions, it is important to have some specific information: better definition of the bone and soft tissue surrounding the lesion and/or exact understanding of the surrounding vascular tree. All these aspects are brilliantly provided by volume-rendered CTA coupled with an IGS system (6,7,11,12,14,25,28). This technique can give the neurosurgeon a better understanding of the real position of the anatomical structures he will encounter during surgery, giving a sort of a preoperative planning.…”

“…It is also a much less invasive diagnostic tool. In recent years diagnostic imaging and software technology has remarkably advanced and it is now possible to postprocess raw images from the volumetric helical scan on an independent station, using a 3D volume-rendering processor (6,7,11,12,14,25,28). The objective of this technique is the optimum craniotomy location and intraoperative 3D guidance to the lesion.…”

Lenticulostriate aneurysms: a case series and review of the literature

“…Almost all present with intracranial hemorrhage in relatively young healthy patients (median 39 years of age). Seven cases have been reported in the pediatric literature, of which two were associated with an underlying AVM 5 6 17–21. Most cases have been treated with open surgical clipping or excision but increasingly less invasive treatment options are becoming available, such as endovascular embolization9 11 13 22 and gamma knife radiosurgery 23.…”

“…Additionally, the LSAs are small vessels and can be in close proximity to the MCA. Image guided surgery has been reported with good results and could be considered for planning, especially in cases where the anatomy is distorted due to an underlying hematoma 5 29. In one series by Gandhi et al ,2 three of six surgically treated patients underwent LSA sacrifice at the time of surgery as the aneurysm was fusiform and could not be excluded from the parent artery.…”