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

Abstract

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.

• Authors: Benoît Pirotte, David Wikler, Philippe David, Florence Lefranc, Jacques Brotchi, Marc Levivier
• Journal: Neurological research (Neurol Res) Vol. 26 Issue 4 Pg. 429-34 (Jun 2004) ISSN: 0161-6412 [Print] England
• PMID: 15198872 (Publication Type: Case Reports, Comparative Study, Journal Article)
• Copyright: Copyright 2004 W.S. Maney and Son Ltd

Topics

• Adult
• Female
• Humans
• Imaging, Three-Dimensional
• Intracranial Aneurysm (surgery)
• Magnetic Resonance Angiography
• Microsurgery (methods)
• Neuronavigation (methods)
• Neurosurgery
• Neurosurgical Procedures