Application of contrast-enhanced constructive interference in steady state magnetic resonance imaging to Leksell GammaPlan for localizing c2-c3 aneurysms: technical note.
OBJECTIVE
We used gadolinium (Gd)-enhanced constructive interference in steady state (CISS) magnetic resonance imaging with the Leksell GammaPlan (LGP; Elekta AB, Stockholm, Sweden) system for accurate preoperative evaluation of the anatomic localization of intradural and/or extradural C2-C3 aneurysms.


METHODS
Anatomic localization of 8 unruptured aneurysms of the C2-C3 segment was evaluated using Gd-enhanced CISS imaging with LGP. Four patients diagnosed with intradural aneurysms, 1 with a combined intraextradural aneurysm, and 1 with an intracavernous aneurysm underwent operation. The aneurysmal localizations diagnosed preoperatively by Gd-enhanced CISS imaging with LGP were compared with intraoperative findings.


RESULTS
By use of Gd-enhanced CISS imaging with LGP, 3-dimensional visualization of the internal carotid artery, aneurysms at the C2-C3 segment, optic nerve, oculomotor nerve, cavernous sinus, and anterior clinoid process was possible in 8 patients. The localization of intradural or combined intra-extradural aneurysms was diagnosed on the basis of the oculomotor nerve and the cavernous sinus depicted in 3-dimensional images. The oculomotor nerve and the cavernous sinus serve as landmarks for the proximal ring on images of the carotico-oculomotor membrane. Intradural or intra-extradural localization of C2-C3 aneurysms with this novel technique was in complete agreement with intraoperative findings in 6 surgical cases.


CONCLUSIONS
This study demonstrated the utility of Gd-enhanced CISS imaging used with LGP for accurate preoperative localization of intradural and/or extradural aneurysms at the C2-C3 segments.
Kawashima
Akitsugu
A
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. akawasima@nij.twmu.ac.jp
Okada
Yoshikazu
Y
Hayashi
Motohiro
M
Kawamata
Takakazu
T
Hori
Tomokatsu
T
D000368:Aged; D000783:Aneurysm / Q000175:diagnosis*; D002426:Cavernous Sinus / Q000473:pathology; D002533:Cerebral Angiography / Q000379:methods; D002574:Cervical Vertebrae / Q000473:pathology; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods
D003287:Contrast Media; D005682:Gadolinium