Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr 19:16:30.
doi: 10.1186/s12880-016-0133-0.

3D rotational fluoroscopy for intraoperative clip control in patients with intracranial aneurysms--assessment of feasibility and image quality

Thomas Westermaier  1 , Thomas Linsenmann  2 , György A Homola  3 , Mario Loehr  2 , Christian Stetter  2 , Nadine Willner  2 , Ralf-Ingo Ernestus  2 , Laszlo Solymosi  3 , Giles H Vince  4
Affiliations

3D rotational fluoroscopy for intraoperative clip control in patients with intracranial aneurysms--assessment of feasibility and image quality

Thomas Westermaier et al. BMC Med Imaging. .

Abstract

Background: Mobile 3D fluoroscopes have become increasingly available in neurosurgical operating rooms. In this series, the image quality and value of intraoperative 3D fluoroscopy with intravenous contrast agent for the evaluation of aneurysm occlusion and vessel patency after clip placement was assessed in patients who underwent surgery for intracranial aneurysms.

Materials and methods: Twelve patients were included in this retrospective analysis. Prior to surgery, a 360° rotational fluoroscopy scan was performed without contrast agent followed by another scan with 50 ml of intravenous iodine contrast agent. The image files of both scans were transferred to an Apple PowerMac® workstation, subtracted and reconstructed using OsiriX® free software. The procedure was repeated after clip placement. Both image sets were compared for assessment of aneurysm occlusion and vessel patency.

Results: Image acquisition and contrast administration caused no adverse effects. Image quality was sufficient to follow the patency of the vessels distal to the clip. Metal artifacts reduce the assessability of the immediate vicinity of the clip. Precise image subtraction and post-processing can reduce metal artifacts and make the clip-site assessable and depict larger neck-remnants.

Conclusion: This technique quickly supplies images at adequate quality to evaluate distal vessel patency after aneurysm clipping. Significant aneurysm remnants may be depicted as well. As it does not require visual control of all vessels that are supposed to be evaluated intraoperatively, this technique may be complementary to other intraoperative tools like indocyanine green videoangiography and micro-Doppler, especially for the assessment of larger aneurysms. At the momentary state of this technology, it cannot replace postoperative conventional angiography. However, 3D fluoroscopy and image post-processing are young technologies. Further technical developments are likely to result in improved image quality.

Keywords: 3D fluoroscopy; Aneurysm surgery; Angiography; Clip control; Contrast; Image quality; Intraoperative; Post-processing; Vessel patency.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Preoperative DSA (a) with 3D reconstruction (b) and intraoperative 3D fluoroscopy after subtraction and reconstruction (c) before clip placement in a patient with a carotid artery aneurysm (case 2). d-f depict the respective projections after surgery. Postoperative DSA confirms a slight clip-induced narrowing of the ICA depicted by intraoperative 3D fluoroscopy
Fig. 2
Fig. 2
MCA aneurysm of case 4. MCA bifurcation before (a) and after (b) placement of the clip
Fig. 3
Fig. 3
5 mm neck remnant after clipping of an MCA aneurysm in plain DSA images (a), 3D reconstructions (b and c) and intraoperative 3D fluoroscopy (d and e)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Zhang H1, Hou C, Zhou Z, Zhang H, Zhou G, Zhang G. Evaluating of small intracranial aneurysms by 64-detector CT Angiography: a comparison with 3-dimensional rotation DSA or surgical findings. J Neuroimaging. 2014;24(2):137-43. - PubMed
    1. Fischer G, Stadie A, Oertel JM. Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery. Acta Neurochir (Wien) 2010;152(9):1519–1525. doi: 10.1007/s00701-010-0723-5. - DOI - PubMed
    1. Siasios I, Kapsalaki EZ, Fountas KN. The role of intraoperative micro-Doppler ultrasound in verifying proper clip placement in intracranial aneurysm surgery. Neuroradiology. 2012;54(10):1109–1118. doi: 10.1007/s00234-012-1023-y. - DOI - PubMed
    1. Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V. Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery. 2003;52(1):132–139. - PubMed
    1. Westermaier T, Linsenmann T, Keler AF, Stetter C, Willner N, Solymosi L, Ernestus RI, Vince GH. Intraoperative cerebral angiography by intravenous contrast administration with 3-dimensional rotational fluoroscopy in patients with intracranial aneurysms: a feasibility study. Neurosurgery. 2015;11(Suppl 2):119–126. - PubMed

Publication types

MeSH terms