Virtual Endoscope-Assisted Intracranial Aneurysm Surgery: Evaluation of Fifty-Eight Surgical Cases

Abstract

Objective: Better visualization of the intracranial aneurysm may improve surgical outcomes. To this aim, we evaluated the effectiveness of using virtual endoscopy (VE) during intracranial aneurysm surgery.

Methods: Fifty-eight patients with 63 intracranial aneurysms were enrolled in this study. Every patient was examined by digital subtraction angiography (DSA) and a randomly selected twenty-six cases were also examined by computed tomography (CT). CT angiography data were linked via imaging software for reconstruction of VE images. All patients were operated on using standard microsurgical procedures. Among these cases, randomly selected cohorts of twenty-six patients with 28 intracranial aneurysms were operated on also using VE-assisted surgical procedures. The surgical results of both groups were compared to determine the efficacy of the VE-assisted surgical procedure.

Results: Aneurysm locations, surgical timing and Hunt-Hess grade distribution were not statistically significant between both groups (p=0.948). However, significantly reduced complication rates and increased post-operative Glasgow outcome scores were observed in the VE group (p<0.05) compared to control.

Conclusion: Aneurysms and surrounding anatomic structures were well depicted by VE in three dimensions with interactive fly-through views. This method improved our surgical results by improving visualization of the aneurysm and increasing surgical orientation. We report that this method can be very helpful to surgeons during intracranial aneurysm surgery and may reduce post-surgical complications.

Key words

Aneurysm - computed tomography - image-guided surgery - remodeling

References

• 1 Yasargil MG. Clinical Considerations Surgery of the Intracranial Aneurysms and Results (Microneurosurgery). Vol. II. Thieme Medical Publisher Stuttgart, New York 1984
• 2 Smith PA, Heath DG, Fishman EK. Virtual angioscopy using spiral CT and real-time interactive volume-rendering techniques.  J Comput Assist Tomogr. 1998;  22 212-214
• 3 Kato Y. et al . Application of three-dimensional CT angiography (3D-CTA) to cerebral aneurysms.  Surg Neurol. 1999;  52 113-121 , discussion 121-122
• 4 Kato Y. et al . Clinical usefulness of 3-D CT endoscopic imaging of cerebral aneurysms.  Neurol Res. 1996;  18 98-102
• 5 Kakizawa Y. et al . “Real” three-dimensional constructive interference in steady-state imaging to discern microneurosurgical anatomy.  Technical note. J Neurosurg. 2003;  98 625-630
• 6 Hayashi H. et al . [Virtual CT endoscopy “Cruising Eye View”: development and clinical applications].  Nippon Igaku Hoshasen Gakkai Zasshi. 1996;  56 135-136
• 7 Fellner F. et al . Virtual cisternoscopy of intracranial vessels: a novel visualization technique using virtual reality.  Magn Reson Imaging. 1998;  16 1013-1022
• 8 Amagasaki K. et al . Current usage of three-dimensional computed tomography angiography for the diagnosis and treatment of ruptured cerebral aneurysms.  J Clin Neurosci. 2004;  11 481-485
• 9 Davis CP. et al . Postprocessing techniques for gadolinium-enhanced three-dimensional MR angiography.  Radiographics. 1997;  17 1061-1077
• 10 Fellner F. et al . MR diagnosis of vein of Galen aneurysmal malformations using virtual cisternoscopy.  Comput Med Imaging Graph. 1999;  23 293-297
• 11 Marro B. et al . Intracranial aneurysm: inner view and neck identification with CT angiography virtual endoscopy.  J Comput Assist Tomogr. 1997;  21 587-589
• 12 Boor S. et al . Virtual endoscopy (VE) of the basal cisterns: its value in planning the neurosurgical approach.  Minim Invas Neurosurg. 1998;  41 177-182
• 13 Futami K. et al . Simulation of clipping position for cerebral aneurysms using three-dimensional computed tomography angiography.  Neurol Med Chir (Tokyo). 2004;  44 6-12 , discussion 13
• 14 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms.  J Neurosurg. 1968;  28 14-20
• 15 Jennett B, Bond M. Assessment of outcome after severe brain damage.  Lancet. 1975;  1 480-484
• 16 Korogi Y. et al . Intracranial aneurysms: detection with three-dimensional CT angiography with volume rendering - comparison with conventional angiographic and surgical findings.  Radiology. 1999;  211 497-506
• 17 Unno N. et al . Virtual angioscopy using 3-dimensional rotational digital subtraction angiography for endovascular assessment.  J Endovasc Ther. 2002;  9 529-534

Correspondence