Accurate Localization of Aneurysm Neck Margins in Clipping of a Carotid Cave Aneurysm Using Intraoperative Dual-Volume 3-Dimensional Volume-Rendering Rotational Angiography
| Autor: | Szu-Kai Hsu, I-Chang Su, Chih-Ta Huang |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Rotation medicine.medical_treatment Aneurysm neck 030218 nuclear medicine & medical imaging 03 medical and health sciences Imaging Three-Dimensional 0302 clinical medicine Aneurysm Monitoring Intraoperative medicine.artery Humans Medicine cardiovascular diseases Aged medicine.diagnostic_test business.industry Intracranial Aneurysm Volume rendering Clipping (medicine) Surgical Instruments medicine.disease Cerebral Angiography Rotational angiography cardiovascular system Hybrid operating room Female Surgery Neurology (clinical) Radiology Internal carotid artery business Carotid Artery Internal 030217 neurology & neurosurgery Cerebral angiography |
| Zdroj: | World Neurosurgery. 101:812.e11-812.e14 |
| ISSN: | 1878-8750 |
| Popis: | Background Full visualization of the aneurysm neck is usually impossible in a classical pterional craniotomy when a paraclinoid aneurysm is located on the opposite side of the internal carotid artery. Optic nerve (ON) retraction is required for better aneurysmal exposure, but ON injuries may occur. Clinical Description In a case of a 70-year-old female harboring a carotid cave aneurysm, we introduced a new method to delineate better the margins of the aneurysm neck by using intraoperative 3-dimensional (3D) rotational angiography (RA) with dual-volume reconstruction. After complete exposure of the aneurysm, we placed a straight clip adjacent to the aneurysm for localization purposes and performed 3D-RA to locate the distal end of the aneurysm neck relative to the localization clip. With a better anatomic understanding of the neck position, we were able to reduce ON retraction and position the clip across the aneurysm neck more precisely. Conclusions With the advantage of a hybrid operating room, we introduced a novel technique to define the margins of the obscured aneurysm neck more clearly by obtaining a 3D-RA dual-volume reconstruction image to locate the aneurysm neck relative to a localization clip. This technique facilitates the clipping procedure and also reduces the risk related to ON retraction during surgical exposure of a paraclinoid aneurysm. |
| Databáze: | OpenAIRE |
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