Accurate Localization of Aneurysm Neck Margins in Clipping of a Carotid Cave Aneurysm Using Intraoperative Dual-Volume Three-dimensional Volume-Rending Rotational Angiography: a case report.

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Accurate Localization of Aneurysm Neck Margins in Clipping of a Carotid Cave Aneurysm Using Intraoperative Dual-Volume Three-dimensional Volume-Rending Rotational Angiography: a case report.

World Neurosurg. 2017 Mar 25;:

Authors: Huang CT, Hsu SK, Su IC

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 (ICA). Optic nerve (ON) retraction is required for better aneurysmal exposure, but ON injuries may occur.
CLINICAL DESCRIPTION: 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 utilizing intraoperative three-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 anatomical 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 hybrid operating theater, 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 not only facilitates the clipping procedure, but also reduces the risk related to ON retraction during surgical exposure of a paraclinoid aneurysm.

PMID: 28351725 [PubMed - as supplied by publisher]

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