title: Intraoperative 3D rotational angiography: an emergency tool for the diagnosis of intracranial aneurysms.
abstract: It was the objective of this report to present a case of recurrent aneurysmal subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) in which an MCA aneurysm was detected by 3D rotational fluoroscopy in an emergency situation. A 44-year-old woman was admitted from an external department after repeated SAH and temporal ICH. Due to progressive anisocoria and cardiocirculatory instability, she was transferred to the operating room without angiography. After a 3D rotational fluoroscopy baseline scan, another scan with 50 ml of iodine contrast agent was performed. The Digital Imaging and Communications in Medicine (DICOM) data sets were subtracted and reconstructed using the OsiriX® free imaging software. No adverse effect was observed during and after the administration of the contrast agent. The entire procedure from positioning of the fluoroscope to the production of utilizable 3D images was completely integrated into the surgical workflow with an image acquisition time of 2 × 24 s. The configuration of the aneurysm, the aneurysm-carrying vessel, and the distal vessel anatomy were well assessable. This technique quickly supplies images at adequate quality to assess the configuration of an intracranial aneurysm and is a useful diagnostic tool if the patient's critical condition prohibits aneurysm diagnostics by angiography or CT angiography.
authors.affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany, westermaier.t@nch.uni-wuerzburg.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Westermaier
authors.forename: Nadine
authors.initials: N
authors.lastname: Willner
authors.forename: Giles H
authors.initials: GH
authors.lastname: Vince
authors.forename: Thomas
authors.initials: T
authors.lastname: Linsenmann
authors.forename: Ralf-Ingo
authors.initials: RI
authors.lastname: Ernestus
authors.forename: Christian
authors.initials: C
authors.lastname: Stetter
mesh_terms: D000328:Adult; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D007430:Intraoperative Care; D020768:Middle Cerebral Artery; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery*
chemical_list: D003287:Contrast Media