Preoperative 3-Dimensional Angiography Data and Intraoperative Real-Time Vascular Data Integrated in Microscope-Based Navigation by Automatic Patient Registration Applying Intraoperative Computed Tomography

Carl, Barbara; Bopp, Miriam; Chehab, Somar; Bien, Siegfried; Nimsky, Christopher

doi:10.1016/j.wneu.2018.02.045

Cited by 23 publications

(15 citation statements)

References 32 publications

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“…Some institutions which have intraoperative CT facility and neuronavigation system can utilize the integration of intraoperative CTA with preoperative CTA or MRA and the operating neurosurgeon can visualize those images from the microscope eyepieces. [ 14 ] In our opinion, a good understanding and knowledge in neuroanatomy and a thorough study of individual preoperative 3D imaging may be sufficient in order to determine best patient's head position on the operating table and bone opening to reach the target with fewer difficulties. There are limitations in both preoperative neuroimaging and intraoperative CTA as small vessels or perforators may not be identified or be visualized in those images.…”

Section: Discussionmentioning

confidence: 99%

Multimodality techniques in microsurgical clipping as the gold standard treatment in the management of basilar tip aneurysm: A case series

et al. 2018

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Introduction:Basilar aneurysms represent 5%–7% of all intracranial aneurysms. The main goal of open surgery is to achieve complete obliteration of the aneurysmal sac using minimal invasive technique while emphasizing on avoidance of complication.Materials and Methods:We performed a retrospective cohort study of nine cases of unruptured basilar tip aneurysm referred to the Fujita Health University Banbuntane-Hotokukai Hospital, Japan. The objective of the study was to analyze the surgical outcomes of unruptured basilar tip aneurysm.Results:Nine patients with unruptured basilar tip aneurysm were referred to our hospital between 2015 and 2017. The median size of the aneurysm and age were 4.00 mm (interquartile range [IQR] = 3.25–6.75 mm) and 58 years (IQR = 54–70 years), respectively. Five patients (55.6%) were presented with multiple intracranial aneurysms. Surgical adjuncts such as intraoperative neuromonitoring, intraoperative indocyanine green (ICG) angiography with dual-image videoangiography (DIVA), and neuroendoscope were used. Two patients developed transient postoperative oculomotor nerve palsy which resolved spontaneously. The median duration of surgery and days of hospitalization were 292 min (IQR = 237.5–350.5 min) and 12 days (IQR = 12–25 days), respectively. There was no mortality recorded in this case series.Conclusion:Microsurgical clipping of basilar tip aneurysm is safe in unruptured basilar tip aneurysm with a low risk of postoperative mortality or morbidity. All complications reported in this case series were transient with no long-term sequalae. The improved safety profile of microsurgical technique is due to the availability of intraoperative neuromonitoring, neuroendoscope, ICG, and DIVA. The application of multimodality technique in neurovascular surgery has also helped to achieve complication avoidance. The obliteration of the aneurysmal sac helps to restore the laminar blood flow in the bifurcation and distal blood vessels and improves the brain perfusion.

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Section: Discussionmentioning

confidence: 99%

Multimodality techniques in microsurgical clipping as the gold standard treatment in the management of basilar tip aneurysm: A case series

et al. 2018

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“…This helps in understanding the 3D anatomy of an aneurysm, parent and branching vessels, bone, and surrounding structures. However, some institutions have intraoperative CT, and they correlate pre- and intraoperative CTA, which can help the neurosurgeons,[ 26 ] but according to the legends of neurosurgery, proper preoperative planning, detailed study of the 3D aneurysm, and detailed knowledge of anatomy are good tools as compared with these recent gadgets. Instead of intraoperative CTA, we use DIVA after injecting intravenous ICG, high-magnification microscope, and endoscope, which allow us to visualize all small perforators and any hidden pathology such as any branch artery surrounding the aneurysm neck.…”

Section: Discussionmentioning

confidence: 99%

Institutional experience of microsurgical management in posterior circulation aneurysm

Sharma¹,

Kumar

Yamada

et al. 2020

Asian J Neurosurg

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Introduction: Posterior circulation aneurysm constitutes 15%–20% of all intracerebral aneurysms. With the advancement of endovascular techniques, the microsurgery for posterior circulation aneurysms has been pushed back a little. Even the International Subarachnoid Aneurysmal Trial gave support to the concepts of endovascular procedures, but microsurgical modality should not be discouraged. We present our institutional experience of microsurgical techniques on posterior circulation aneurysms. Materials and Methods: We performed a retrospective analysis of 37 patients of posterior circulation aneurysm from 2015 to 2019, referred to Bantane Hospital, Japan. We included all posterior circulation aneurysms such as basilar tip, basilar trunk, and vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysms, admitted and treated with clipping or bypass and trapping. We assessed the outcome as measured by modified Rankin Score (mRS), complications, and mortality. Results: Out of 37 patients, 10 cases were a basilar tip, one case was the basilar trunk, and 26 cases were VA-PICA aneurysm. Intraoperatively, neuromonitoring, indocyanine green dye, dual-image videoangiography (DIVA), and neuro endoscope were used. Two patients of basilar tip aneurysm developed third cranial nerve paresis and six patients of VA-PICA aneurysm developed lower cranial nerve paresis which resolved spontaneously. All the patients were discharged with mRS of 0 or 1. No mortality was recorded in our study. Conclusion: Microsurgical clipping of posterior circulation aneurysm is safe in unruptured aneurysm with a very low risk of mortality and morbidity under experienced hands. All postoperative complications in our study were transient and resolved with time with no residual deficits. Preoperative simulation, intraoperative neuromonitoring, DIVA, and neuro endoscope help achieve complete obliteration of aneurysmal sac and avoid complications.

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“…Details describing the setup were previously published, and no major modifications were necessary to apply the technique. [ 14 , 15 , 16 , 17 ].…”

Section: Methodsmentioning

confidence: 99%

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

et al. 2021

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Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.

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Preoperative 3-Dimensional Angiography Data and Intraoperative Real-Time Vascular Data Integrated in Microscope-Based Navigation by Automatic Patient Registration Applying Intraoperative Computed Tomography

Cited by 23 publications

References 32 publications

Multimodality techniques in microsurgical clipping as the gold standard treatment in the management of basilar tip aneurysm: A case series

Multimodality techniques in microsurgical clipping as the gold standard treatment in the management of basilar tip aneurysm: A case series

Institutional experience of microsurgical management in posterior circulation aneurysm

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

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