title: Cerebral Angiography for Multimodal Surgical Planning in Epilepsy Surgery: Description of a New Three-Dimensional Technique and Literature Review.
abstract: OBJECTIVE
  Cerebrovascular imaging is critical for safe and accurate planning of Stereo-ElectroEncephaloGraphy (SEEG) electrode trajectory. We developed a new technique for Cone Beam Computed Tomography (CBCT) Three-Dimensional Digital Subtraction Angiography (3D DSA).
  
  
  METHODS
  The workflow core is the acquisition of computed tomography datasets without (bone mask) and with selective injection of contrast medium in the main brain-feeding arteries, followed by dataset registration and subtraction. The images were acquired with the O-armTM 1000 System (Medtronic). Images were postprocessed with FSL software package. We retrospectively analyzed 191 3D DSA procedures and qualitatively analyzed the quality of each 3D DSA dataset.
  
  
  RESULTS
  The quality of 3D DSA was good in 150 procedures, sufficient in 37, and poor in 4. 3D rendering of the vascular tree was helpful for both SEEG implantation and resective surgery planning. Angiography complications occurred in only one procedure that was aborted due to a major allergic reaction to contrast medium. No other complications directly related to 3D DSA occurred. Minor intracerebral hemorrhage occurred in 2/191 patients after SEEG implantation, with no permanent sequelae.
  
  
  CONCLUSIONS
  CBCT 3D DSA is a safe diagnostic procedure for SEEG electrode trajectory planning and for 3D reconstructions of the vascular tree in multimodal scenes for resections. The high fidelity and geometric accuracy contribute to the safety of electrode implantation.
authors.affiliation: Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Hospital, Milan, Italy. Electronic address: francesco.cardinale@ospedaleniguarda.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardinale
authors.affiliation: Department of Neuroradiology, Niguarda Hospital, Milan, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Pero
authors.affiliation: Department of Neuroradiology, Niguarda Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Quilici
authors.affiliation: Department of Neuroradiology, Niguarda Hospital, Milan, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Piano
authors.affiliation: Department of Medical Physics, Niguarda Hospital, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Colombo
authors.affiliation: Department of Medical Physics, Niguarda Hospital, Milan, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Moscato
authors.affiliation: Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Hospital, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Castana
authors.affiliation: Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Hospital, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casaceli
authors.affiliation: Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Hospital, Milan, Italy.
authors.forename: Dalila
authors.initials: D
authors.lastname: Fuschillo
authors.affiliation: Department of Neuroradiology, Niguarda Hospital, Milan, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Gennari
authors.affiliation: Department of Neurosurgery, Niguarda Hospital, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cenzato
authors.affiliation: Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Hospital, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lo Russo
authors.affiliation: Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Hospital, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cossu
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D054893:Cone-Beam Computed Tomography; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D055815:Young Adult
keywords: Cone beam computed tomography; Digital subtraction angiography; Epilepsy surgery; Image processing; Intracerebral electrodes; StereoElectroEncephaloGraphy