Magnetic resonance angiography image guidance for the microsurgical clipping of intracranial aneurysms: a report of two cases

To describe the integration of magnetic resonance angiography (MRA) in neuronavigation procedures for microsurgery of intracranial aneurysms. MRA was combined with standard magnetic resonance image (MRI) acquisition in the image-guided planning for the microsurgical clipping of a saccular aneurysm i...

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Bibliographic Details
Published in:Neurological research (New York) 2004-06, Vol.26 (4), p.429-434
Main Authors: Pirotte, Benoît, Wikler, David, David, Philippe, Lefranc, Florence, Brotchi, Jacques, Levivier, Marc
Format: Article
Language:English
Subjects:
Adult
CEREBRAL ANEURYSM
Female
Humans
IMAGE-GUIDED SURGERY
Imaging, Three-Dimensional
Intracranial Aneurysm - surgery
MAGNETIC RESONANCE ANGIOGRAPHY
Microsurgery - methods
NEURONAVIGATION
Neuronavigation - methods
Neurosurgery
Neurosurgical Procedures
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Summary:To describe the integration of magnetic resonance angiography (MRA) in neuronavigation procedures for microsurgery of intracranial aneurysms. MRA was combined with standard magnetic resonance image (MRI) acquisition in the image-guided planning for the microsurgical clipping of a saccular aneurysm in two patients (one 3-mm large middle cerebral artery and one 8-mm large pericallosal artery aneurysm, diagnosed by catheter angiography in both patients) using two different neurosurgical navigation systems. Conventional 3-D T1-weighted MRI with gadolinium and MRA pulse sequences were acquired in frameless stereotactic conditions the day before surgery and thereafter registered, allowing the definition a minimally invasive straight trajectory to the aneurysm neck. MRA-guided neurosurgery allowed a direct approach to the aneurysms at their proper location, reducing the invasiveness of the approach by tailoring the bone opening and reducing the duration and extension of brain retraction. The technique also avoided unnecessary dissection and exposure of the main trunks and collateral vessels. The aneurysms were successfully eradicated without complication. Integration of MRA in the planning and neuronavigation procedure for intracranial aneurysms may minimize the morbidity related to the surgical approach. This technique may be applicable more routinely using standard neuronavigation equipment.
ISSN:0161-6412
1743-1328
DOI:10.1179/016164104225016056