Abstract
This study aims to explore the utility of angiographic computed tomography (CT) in the diagnosis and treatment of neurovascular pathologies in the vicinity of cranial base. Two cases of cranial base dural arteriovenous fistula, one internal carotid pseudoaneurysm and one PICA aneurysm were demonstrated utilizing the angiographic CT for obtaining significant image details on the relative location of the diseases against the neighboring bony structure. An angiography suite outfitted with conventional DSA and rotational volume cone-beam was used, angiographic CT images being concomitantly produced together with the routine angiographic modalities. By virtue of the angiographic CT images integrating the selective angiography and reconstructed cranial base tomography, we succeeded in getting significant information on the relative location of various vascular diseases to the skull base, greatly facilitating the diagnosis and treatment procedures.
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Ralf Alfons Kockro, Zurich, Switzerland
The degree of understanding individual pathology and anatomy is directly dependant on the quality of imaging. In this interesting paper, Li et al. report on the application of a flat-panel detector angiographic suite which enables simultaneous angiographic CT imaging and angiography. Making use of this dual imaging information, bone tissue can be visualized in direct context to the angiographic display of vasculature, which facilitates diagnosis and treatment planning of vascular lesions in the area of the skull base. In contrast to CTA, angiographic techniques enable a selective and higher resolution vascular display, which proves to be of significant benefit in the chosen illustrative cases. Detailed 3D reconstructions of the angiographic and angiographic CT data, possibly displayed in a fused mode with MRI derived soft tissue, would certainly further enhance the potential of this technique for surgical planning.
Veit Rohde, Goettingen, Germany
The authors described the use of angiographic CT for diagnostic work-up of aneurysms and dural arteriovenous fistulas. Angiographic CT not only displays the vascular malformation with high resolution but also allows delineating the spatial relation of the malformation to the surrounding bony structures of the skull base, which is without any doubt of value for the neurosurgeon and neuroradiologist embarking to treat these complex vascular diseases. However, the next step to come is to transfer the angiographic CT information into the operative field by integration of image data into a neuronavigational system as shown for CT angiography (1). In the four presented cases, conventional angiography was performed first, and the positioned angiography catheter was then used to inject contrast medium to obtain the angiographic CT images. Very recently intravenous angiographic CT was used for post-operative control after aneurysm clipping (2). In contrast to intraarterial angiographic CT, intravenous angiographic CT could be performed without intraarterial catheter placement and represents a non-invasive imaging modality. This raises the question if possibly intravenous angiographic CT is likewise capable of providing the neurosurgeon and the neuroradiologist with such intriguing images as shown in this case series.
References
1. Rohde V, Hans FJ, Mayfrank L, Dammert S, Gilsbach JM, Coenen V. How useful is the 3D, surgeon’s perspective-adjusted visualisation of the vessel anatomy during aneurysm surgery? A prospective clinical trial. Neurosurg Rev 30: 209–17, 2007
2. Wachter D, Psychogios M, Knauth M, Rohde V. IvACT after aneurysm clipping as an alternative to digital substraction angiography—first experiences. Cen Eur Neurosurg 71:121–125, 2010
Jun Li and Feng Wan contributed equally to this work.
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Li, J., Wan, F., Chen, G. et al. The utility of angiographic CT in the diagnosis and treatment of neurovascular pathologies in the vicinity of cranial base. Neurosurg Rev 34, 243–248 (2011). https://doi.org/10.1007/s10143-010-0298-x
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DOI: https://doi.org/10.1007/s10143-010-0298-x