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Intraoperative 3D rotational angiography: an emergency tool for the diagnosis of intracranial aneurysms

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Abstract

It was the objective of this report to present a case of recurrent aneurysmal subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) in which an MCA aneurysm was detected by 3D rotational fluoroscopy in an emergency situation. A 44-year-old woman was admitted from an external department after repeated SAH and temporal ICH. Due to progressive anisocoria and cardiocirculatory instability, she was transferred to the operating room without angiography. After a 3D rotational fluoroscopy baseline scan, another scan with 50 ml of iodine contrast agent was performed. The Digital Imaging and Communications in Medicine (DICOM) data sets were subtracted and reconstructed using the OsiriX® free imaging software. No adverse effect was observed during and after the administration of the contrast agent. The entire procedure from positioning of the fluoroscope to the production of utilizable 3D images was completely integrated into the surgical workflow with an image acquisition time of 2 × 24 s. The configuration of the aneurysm, the aneurysm-carrying vessel, and the distal vessel anatomy were well assessable. This technique quickly supplies images at adequate quality to assess the configuration of an intracranial aneurysm and is a useful diagnostic tool if the patient’s critical condition prohibits aneurysm diagnostics by angiography or CT angiography.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Thomas Westermaier.

Electronic supplementary material

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A 360° rotational view of the cerebral vessels. A 3D rotational fluoroscopy scan and image post-processing using the automated subtraction and reconstruction functions of the OsiriX® free software served for acquisition of this image (AVI 8008 kb)

Video

A 360° rotational view of the cerebral vessels. A 3D rotational fluoroscopy scan and image post-processing using the automated subtraction and reconstruction functions of the OsiriX® free software served for acquisition of this image (AVI 8008 kb)

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Westermaier, T., Willner, N., Vince, G.H. et al. Intraoperative 3D rotational angiography: an emergency tool for the diagnosis of intracranial aneurysms. Emerg Radiol 22, 97–100 (2015). https://doi.org/10.1007/s10140-014-1252-y

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Keywords

  • Subarachnoid hemorrhage
  • Intracerebral hemorrhage
  • Aneurysm
  • Rupture
  • Intravenous contrast
  • 3D fluoroscopy