Application of Three-dimensional Cerebral Angiography for Presurgical Simulation of Cerebral Aneurysm Clipping

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  • ITO Yoshiro
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
  • SATO Masayuki
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
  • MATSUMARU Yuji
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba
  • MARUSHIMA Aiki
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
  • MINAMIMOTO Shinya
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
  • HINO Tenyu
    Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba
  • HAYAKAWA Mikito
    Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba
  • ISHIKAWA Eiichi
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
  • MATSUMURA Akira
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba

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  • 開頭クリッピング術の手術シミュレーションとしての3次元脳血管撮影

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<p>Recent developments in cerebral angiography equipment and workstations have made it possible to produce clear angiograms and useful images for neurosurgery. At our institution, we routinely perform cerebral aneurysm clipping after presurgical simulation using imaging data obtained using three-dimensional cerebral angiography. This report describes the clinical significance of three-dimensional cerebral angiography in cerebral aneurysm clipping.</p><p>Materials and Methods: Three-dimensional rotational angiography (3D-RA) and three-dimensional rotational venography (3D-RV) were performed on cerebral angiography, and the resulting imaging data were processed on a workstation. Depending on the requirements of each case, we created 3D-RA, 3D-RV, slab maximum intensity projection, and fusion images for presurgical simulation, followed by cerebral aneurysm clipping.</p><p>Results: Thirty patients underwent cerebral unruptured aneurysm clipping using this technique. Clipping was completed in all cases. The treatment complications were symptomatic cerebral infarction in one (3%) patient and deterioration in modified Rankin Scale score (≥2) at discharge compared to the preoperative scores in two (7%) patients. No cerebral contusions were observed.</p><p>Conclusion: Cerebral angiography images were processed using a workstation for presurgical simulation. We were able to recognize the perforators and microvessels surrounding the aneurysm, cortical vein structure, and positioning of the existing coils in detail. This technique is useful for the presurgical simulation of cerebral aneurysm clipping.</p>

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