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Three-dimensional rotational angiography for craniotomy planning and postintervention evaluation of intracranial aneurysms

Utilizzo dell’angiografia rotazionale 3D per la strategia d’approccio chirurgico craniotomico e nel controllo post-operatorio degli aneurismi intracranici

  • Neuroradiology / Neuroradiologia
  • Published:
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Abstract

Purpose

The authors evaluated the usefulness of three-dimensional rotational angiography (3DRA) in surgical planning and postoperative evaluation of cerebral aneurysms.

Materials and methods

A total of 111 consecutive aneurysms in 100 patients (32 emergency referrals due to haemorrhage) were evaluated with 3DRA over a period of 3 years. The rotational study was always performed with a single injection of 20 cc of contrast agent in the afferent vessel after diagnostic cerebral angiography in the two orthogonal projections. Three-dimensional reconstructions were obtained for the pre- and postoperative assessment.

Results

Three-dimensional RA provides a virtual view of the surgical field with the same orientation required for the surgical approach and, compared with surgical findings, reliably defined location, orientation, morphology and relationship with parent vessels of the aneurysm in all cases. Postoperatively, it allowed better assessment of any residual lesion and of the relationship between surgical clips and parent vessels, compared with standard 2D angiography.

Conclusions

3DRA is a reliable method for preliminary assessment of cerebral aneurysms undergoing surgery. It provides multiple projections with a preview of the surgical field and study of lesion characteristics, which can help achieve faster and safer surgery. Compared with 2D angiography, the 3D model, with its multiple views, allows better assessment of postoperative outcomes. The method also significantly reduces the number of angiographic projections and therefore radiation and contrast-medium dose to the patient.

Riassunto

Obiettivo

Scopo del presente lavoro è stato valutare l’utilità dell’angiografia rotazionale 3D (3DRA) per la pianificazione del trattamento chirurgico degli aneurismi cerebrali e per la valutazione post-operatoria.

Materiali e metodi

Sono stati valutati 111 aneurismi con 3DRA in 100 pazienti (32 in urgenza dopo emorragia) in 3 anni. Lo studio rotazionale è stato sempre eseguito consingola iniezione di 20 cc di mezzo di contrasto (MdC) del vaso afferente alla lesione dopo panangiografia cerebrale diagnostica nelle due proiezioni ortogonali. Sono state cosÌ ottenute ricostruzioni 3D nel work-up pre- e postoperatorio.

Risultati

La 3DRA ha permesso la visualizzazione virtuale del campo operatorio con l’orientamento necessario per l’approccio chirurgico e, confrontata con i reperti chirurgici, in tutti i casi ha definito con estrema affidabilità la sede, l’orientamento, la morfologia e il rapporto con i vasi parenti dell’aneurisma. Nel post-operatorio, rispetto all’angiografia standard 2D, ha permesso una migliore valutazione di eventuali residui della lesione e dei rapporti delle clip chirurgiche con i vasi parenti.

Conclusioni

La 3DRA è una metodica affidabile per la valutazione preliminare degli aneurismi cerebrali candidati ad intervento chirurgico in termini di previsualizzazione del campo operatorio e studio delle caratteristiche della lesione, utili per interventi più rapidi e sicuri. Rispetto all’angiografia 2D, grazie alla multiproiettività del modello 3D, permette una migliore valutazione degli esiti post-operatori. La metodica inoltre consente di ridurre significativamente il numero di proiezioni angiografiche e quindi la dose di esposizione e MdC al paziente.

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Authors and Affiliations

  1. Dipartimento di Bioimmagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico. A. Gemelli, L.go Vito 1, 00168, Roma, Italy

    A. Pedicelli, F. Desiderio, M. Rollo, T. Verdolotti, F. D’Argento, L. Bonomo & C. Colosimo

  2. Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Policlinico. A. Gemelli, L.go Vito 1, 00168, Roma, Italy

    G. Esposito, A. Albanese & G. Maira

Authors
  1. A. Pedicelli
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  2. F. Desiderio
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  3. G. Esposito
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  4. M. Rollo
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  5. A. Albanese
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  6. T. Verdolotti
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  7. F. D’Argento
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  8. L. Bonomo
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  9. G. Maira
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  10. C. Colosimo
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Correspondence to A. Pedicelli.

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Pedicelli, A., Desiderio, F., Esposito, G. et al. Three-dimensional rotational angiography for craniotomy planning and postintervention evaluation of intracranial aneurysms. Radiol med 118, 415–430 (2013). https://doi.org/10.1007/s11547-012-0869-8

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  • DOI: https://doi.org/10.1007/s11547-012-0869-8

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