title: Accurate Localization of Aneurysm Neck Margins in Clipping of a Carotid Cave Aneurysm Using Intraoperative Dual-Volume 3-Dimensional Volume-Rendering Rotational Angiography.
abstract: BACKGROUND
  Full visualization of the aneurysm neck is usually impossible in a classical pterional craniotomy when a paraclinoid aneurysm is located on the opposite side of the internal carotid artery. Optic nerve (ON) retraction is required for better aneurysmal exposure, but ON injuries may occur.
  
  
  METHODS
  In a case of a 70-year-old female harboring a carotid cave aneurysm, we introduced a new method to delineate better the margins of the aneurysm neck by using intraoperative 3-dimensional (3D) rotational angiography (RA) with dual-volume reconstruction. After complete exposure of the aneurysm, we placed a straight clip adjacent to the aneurysm for localization purposes and performed 3D-RA to locate the distal end of the aneurysm neck relative to the localization clip. With a better anatomic understanding of the neck position, we were able to reduce ON retraction and position the clip across the aneurysm neck more precisely.
  
  
  CONCLUSIONS
  With the advantage of a hybrid operating room, we introduced a novel technique to define the margins of the obscured aneurysm neck more clearly by obtaining a 3D-RA dual-volume reconstruction image to locate the aneurysm neck relative to a localization clip. This technique facilitates the clipping procedure and also reduces the risk related to ON retraction during surgical exposure of a paraclinoid aneurysm.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan.
authors.forename: Chih-Ta
authors.initials: CT
authors.lastname: Huang
authors.affiliation: Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan; Department of Nursing, Tzu Hui Institute of Technology, Pingtung County, Taiwan.
authors.forename: Szu-Kai
authors.initials: SK
authors.lastname: Hsu
authors.affiliation: Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. Electronic address: ichangsu@gmail.com.
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Su
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D016343:Monitoring, Intraoperative / Q000379:methods*; D012399:Rotation; D013525:Surgical Instruments
keywords: 3-dimensional; Cerebral angiography; Imaging; Intracranial aneurysm; Paraclinoid aneurysm