title: Fusion of intraoperative three-dimensional rotational angiography and flat-panel detector computed tomography for cerebrovascular neuronavigation.
abstract: OBJECTIVE
  We introduce a technique that uses intraoperative flat-panel detector computed tomography (FD-CT) and three-dimensional rotational angiography (3D-RA) acquired in the hybrid operative suite to provide full neuronavigation capabilities during cerebrovascular surgery without the use of preoperative imaging studies.
  
  
  METHODS
  An Artis Zeego FD system (Siemens AG, Forchheim, Germany), mounted on a robotic C-arm was used during the clipping of an aneurysm to acquire intraoperative FD-CT and 3D-RA images. These images were then fused via the use of BrainLab iPlan 3.0 software and sent to a Vector Vision Sky neuronavigation system (NNS; BrainLAB, Heimstetten, Germany) to provide intraoperative image guidance.
  
  
  RESULTS
  The use of intraoperative FD-CT and 3D-RA with a NNS allowed for accurate visualization of the vascular anatomy and localization of pathology. In a case of a patient harboring two aneurysms, one that was surgically clipped and a second that was treated endovascularly, the 3D-RA clearly showed neck remnants at both aneurysms. Use of the NNS assisted in further clip placement for obliteration of these neck remnants.
  
  
  CONCLUSIONS
  Hybrid operating suites equipped with FD-CT, 3D-RA, and NNS capabilities can be used to provide intraoperative 3D image guidance during cerebrovascular surgery with excellent accuracy and without the need for preoperative angiography. Furthermore, this technique required less than 15 minutes for image acquisition and utilizes digitally subtracted angiographic images that are superior to conventional CT or MRI for the imaging of cerebrovascular pathology.
authors: Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Lewis Z
authors: LZ
authors: Leng
authors: David G
authors: DG
authors: Rubin
authors: Athos
authors: A
authors: Patsalides
authors: Howard A
authors: HA
authors: Riina
mesh_terms: D017536:Carotid Artery, Common; D002406:Catheterization, Peripheral; D002533:Cerebral Angiography / Q000295:instrumentation / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery; D007432:Intraoperative Period; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*