title: Intraoperative cerebral angiography by intravenous contrast administration with 3-dimensional rotational fluoroscopy in patients with intracranial aneurysms: a feasibility study.
abstract: BACKGROUND
  Intraoperative imaging of cerebral aneurysms may be desirable in emergency situations with large space-occupying hematomas or to visualize vessels after clip placement. Mobile 3-dimensional fluoroscopes are available in a number of neurosurgical departments and may be useful in combination with simple image postprocessing to depict cerebral vessels.
  
  
  OBJECTIVE
  To assess whether intracranial aneurysms are detectable with appropriate image quality with intraoperative 3-dimensional fluoroscopy with intravenous contrast administration.
  
  
  METHODS
  Eight patients were included in the study. The patients' heads were fixed in a radiolucent Mayfield clamp. First, a rotational fluoroscopy scan was performed without contrast agent. Then, a second scan with 50 mL iodine contrast agent was performed. The DICOM (digital imaging and communications in medicine) data of both scans were transferred to an Apple PowerMac workstation, subtracted, and reconstructed with OsiriX imaging software. The images were compared with preoperative angiograms.
  
  
  RESULTS
  No adverse effects were observed during contrast administration. The entire procedure from fluoroscope positioning to the production of usable 3-dimensional images took 5 to 6 minutes with an image acquisition time of 2 × 24 seconds. The configuration of the aneurysm and the vessel anatomy were assessable. Previous coiling limited image quality in 1 patient.
  
  
  CONCLUSIONS
  This technique quickly provides images of adequate quality to assess the configuration of intracranial aneurysms, which may be helpful when immediate intraoperative information about intracranial vessel pathologies is required. The positioning of the fluoroscope, image acquisition, and processing can be completely integrated into the surgical workflow.
authors.affiliation: *Department of Neurosurgery and ‡Neuroradiology, University of Wuerzburg, Wuerzburg, Germany; §Abteilung für Neurochirurgie, Klinikum Klagenfurt, Klagenfurt am Woerthersee, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Westermaier
authors.forename: Thomas
authors.initials: T
authors.lastname: Linsenmann
authors.forename: Almuth F
authors.initials: AF
authors.lastname: Keßler
authors.forename: Christian
authors.initials: C
authors.lastname: Stetter
authors.forename: Nadine
authors.initials: N
authors.lastname: Willner
authors.forename: Laszlo
authors.initials: L
authors.lastname: Solymosi
authors.forename: Ralf-Ingo
authors.initials: RI
authors.lastname: Ernestus
authors.forename: Giles H
authors.initials: GH
authors.lastname: Vince
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012984:Software
chemical_list: D003287:Contrast Media