From Intraoperative Angiography to Advanced Intraoperative Imaging: The Geneva Experience

  • Karl SchallerEmail author
  • Marc Kotowski
  • Vitor Pereira
  • Daniel Rüfenacht
  • Philippe Bijlenga
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 109)



We aimed at the integration of recent flat panel technology in a joint interventional suite for neurosurgeons and neuroradiologists.


A Flat Panel system, allowing for intraoperative performance of 2D and 3D DSA, for automated segmentation of vascular structures, and for performance of computed tomography, was connected with a surgical microscope and neuronavigation. All surgical and neurointerventional cases were monitored and stored in a prospective data base.


N=99 patients were treated neurosurgically: N=63 aneurysm clippings in n=51 patients; n=12 resections of arteriovenous malformations (AVM); n=6 clippings/excisions of dural AV fistulae (dAVF); n=3 EC-IC bypass procedures; n=10 resections of skull base tumours; n=17 spine procedures. All patients had intraoperative imaging for angiographic control and/or for anatomical allocation. Intraoperative 3D-rotational angiography was performed n=54 times in n=42 patients in <15min each, with repositioning of aneurysm clips in n=9 patients.


This hybrid neuro-interventional suite opens a new avenue for intraoperative imaging by the provision of highly resoluted angiographic or CT images, which may be co-registered with a navigation system. In addition, the workflow in treatment of aneurysmal SAH can be improved, as all diagnostic and therapeutic measures can be taken without having to move the patient to other facilities.


Flat panel Intraoperative angiography Intraoperative CT Intraoperative imaging Vascular neurosurgery 


  1. 1.
    Nimsky C, von Keller B, Schlaffer S, Kuhnt D, Weigel D, Ganslandt O, Buchfelder M (2009) Updating navigation with intraoperative imaging data. Top Magn Reson Imaging 19:197–204PubMedCrossRefGoogle Scholar
  2. 2.
    Matula C, Rössler K, Reddy M, Schindler E, Koos WT (1998) Intraoperative computed tomography guided neuronavigation: concepts, efficiency, and work flow. Comput Aided Surg 3:174–182PubMedCrossRefGoogle Scholar
  3. 3.
    Gerlach R, du Mesnil de Rochemont R, Gasser T, Marquardt G, Reusch J, Imoehl L, Seifert V (2008) Feasibility of Polestar N20, an ultra-low-field intraoperative magnetic resonance imaging system in resection control of pituitary macroadenomas: lessons learned from the first 40 cases. Neurosurgery 63:272–284Google Scholar
  4. 4.
    Jankovski A, Francotte F, Vaz G, Fomekong E, Duprez T, Van Boven M, Docquier MA, Hermoye L, Cosnard G, Raftopoulos C (2008) Intraoperative magnetic resonance imaging at 3-T using a dual independent operating room-magnetic resonance imaging suite: development, feasibility, safety, and preliminary experience. Neurosurgery 63:412–426PubMedCrossRefGoogle Scholar
  5. 5.
    Alexander TD, Macdonald RL, Weir B, Kowalczuk A (1996) Intraoperative angiography in cerebral aneurysm surgery: a perspective study of 100 craniotomies. Neurosurgery 39:10–18PubMedCrossRefGoogle Scholar
  6. 6.
    Raabe A, Beck J, Rohde S, Berkefeld J, Seifert V (2006) Three-dimensional rotational angiography guidance for aneurysm surgery. J Neurosurg 105:406–411PubMedCrossRefGoogle Scholar
  7. 7.
    Meyer B, Urbach H, Schaller C, Baslam M, Nordblom J, Schramm J (2004) Immediate postoperative angiography after aneurysm clipping – implications for quality control and further guidance of management. Zentralbl Neurochir 65:49–56PubMedCrossRefGoogle Scholar
  8. 8.
    De Oliveira JG, Beck J, Seifert V, Teixeira MJ, Raabe A (2007) Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography. Neurosurgery 61(3 Suppl):63–73PubMedGoogle Scholar
  9. 9.
    Uhl E, Zausinger S, Morhard D, Heigl T, Scheder B, Rachinger W, Schichor C, Tonn J (2009) Intraoperative computed tomography with integrated navigation system in a multidisciplinary operating suite. Neurosurgery 64(5 Suppl 2):231–240PubMedGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2011

Authors and Affiliations

  • Karl Schaller
    • 1
    Email author
  • Marc Kotowski
    • 1
  • Vitor Pereira
    • 1
  • Daniel Rüfenacht
    • 1
  • Philippe Bijlenga
    • 1
  1. 1.University of Geneva Medical Center, Faculty of MedicineUniversity of GenevaGenevaSwitzerland

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