Real-Time Image Guidance for Open Vascular Neurosurgery Using Digital Angiographic Roadmapping

Ayad, Michael; Ulm, Arthur J.; Yao, Tom L; Eskioglu, Eric; Mericle, Robert A.

doi:10.1227/01.neu.0000289714.18297.41

Cited by 13 publications

(11 citation statements)

References 16 publications

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“…4 A portable vascular C-arm has also been used to create an angiographic road map by using DSA to guide open cerebrovascular procedures as a form of neuronavigation. 3 Rotational 3D DSA provides more information about complex cerebrovascular anatomical detail than conventional DSA. 1,5,17,19,22 The 3D DSA images are reconstructed from 2 separate rotational angiography acquisitions: a mask run and a contrast run.…”

Section: Discussionmentioning

confidence: 99%

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Stidd¹,

Wewel²,

Ghods³

et al. 2014

JNS

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Paralleling the rapid development of neuroimaging technology, the introduction of neuronavigation in the 1980s has revolutionized the surgery of intracranial diseases.2,11 Neuronavigation based on CT or MRI studies has tailored surgical interventions to individual anatomy and pathology, with minimal disruption to the physical and functional architecture of the brain. Vascular anatomy is best appreciated with digital subtraction angiography (DSA), which remains the gold standard for imaging of cerebrovascular pathology. Both CT angiography (CTA) and MR angiography (MRA) have lower detection sensitivity and inferior spatial resolution relative to DSA for aneurysms smaller than 3 mm. 1,19,20 The use of DS angiograms as source images for neuronavigation, however, has been limited because DSA studies typically lack the soft-tissue information necessary to register the radiographic image space to the head in the physical space. Images from DSA typically require fusion with CT or MR images for coregistration.Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration Object. Cerebrovascular lesions can have complicated abnormal anatomy that is not completely characterized by CT or MR angiography. Although 3D rotational angiography provides superior spatial and temporal resolution, catheter angiograms are not easily registered to the patient, limiting the use of these images as a source for neuronavigation. However, 3D digital subtraction angiography (DSA) contains not only vascular anatomy but also facial surface anatomy data. The authors report a novel technique to register 3D DSA images by using only the surface anatomy contained within the data set without having to fuse the DSA image set to other imaging modalities or use fiducial markers.Methods. A cadaver model was first created to assess the accuracy of neuronavigation based on 3D DSA images registered by facial surface anatomy. A 3D DSA scan was obtained of a formalin-fixed cadaver head, with acquisitions of mask and contrast runs. The right common carotid artery was injected prior to the contrast run with a 45% contrast solution diluted with water-soluble red liquid latex. One week later, the head was registered to a neuronavigation system loaded with the 3D DSA images acquired earlier using facial surface anatomy. A right pterional craniotomy was performed and 10 different vascular landmarks were identified and measured for accuracy using the neuronavigation system. Neuronavigation based only on 3D DSA was then used to guide an open clipping procedure for a patient who presented with a ruptured distal lenticulostriate aneurysm.Results. The accuracy of the measurements for the cadaver model was 0.71 ± 0.25 mm (mean ± SE), which is superior to the 1.8-5 mm reported for neuronavigation. The 3D DSA-based navigation-assisted surgery for the distal lenticulostriate aneurysm aided in localization, resulting in a small craniotomy and minimal brain dissection.Conclusions. This is the first example of frameless neu...

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Section: Discussionmentioning

confidence: 99%

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Stidd¹,

Wewel²,

Ghods³

et al. 2014

JNS

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show abstract

“…Finally superficial landmarks on the surface of the brain or at the resection site can help in the exact localization of a possible residual AVM. 2 Murayama et al 11 described their initial experience with an endovascular operating suite and confirmed its effectiveness and practicality in intracranial vascular procedures. However, they did not report the use of intraoperative rotational 3D angiography.…”

Section: Discussionmentioning

confidence: 92%

Intraoperative biplanar rotational angiography during neurovascular surgery

Dehdashti¹,

Thines²,

Costa³

et al. 2009

JNS

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“…Intraoperative angiography has been widely used during brain operations mainly for the therapy of complex AVMs and has been shown in several cases that the procedure was altered because of the knowledge provided by intraoperative angiography [5 -7] . Furthermore, several studies have proven that intraoperative angiography provides a useful tool also in spinal AVM surgery for roadmapping the lesion [1] or for the detection of residual feeding arteries [3,4] . In several cases, intraoperative angiography led to a change of the surgical procedure as well [8] .…”

Section: Discussion ▼mentioning

confidence: 99%

Indication, Technique and Benefit of Intraoperative Spinal Digital Subtraction Angiography with a new Setting in a Patient with Spinal Arteriovenous Malformation

et al. 2011

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Real-Time Image Guidance for Open Vascular Neurosurgery Using Digital Angiographic Roadmapping

Abstract: Angiographic roadmapping is an effective intraoperative navigation tool for resection of vascular lesions that has not been previously described and offers several advantages to frameless stereotaxy.

Cited by 13 publications

References 16 publications

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Intraoperative biplanar rotational angiography during neurovascular surgery

Indication, Technique and Benefit of Intraoperative Spinal Digital Subtraction Angiography with a new Setting in a Patient with Spinal Arteriovenous Malformation

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