Utility of Three-dimensional Computed Tomographic Angiography for Assessment of Relationships between the Vertebrobasilar System and the Cranial Base

Abstract OBJECTIVE The optimal surgical exposure for basilar tip aneurysms is dictated by the relationship of the basilar bifurcation to the cranial base. This study was designed to evaluate three-dimensional computed tomographic angiography as a means of obtaining detailed anatomic information on the basilar artery and the surrounding cranial base in individual patients before surgery. METHODS We studied 30 patients using three-dimensional computed tomographic angiographic reconstructions from 1-mm computed tomographic slices. Detailed anatomic measurements were performed to define the relationship between the basilar artery and the cranial base. Particular attention was paid to the height of the dorsum sellae and its relationship to the basilar bifurcation. RESULTS The heights of the basilar apex and the vertebrobasilar junction, relative to the cranial base, were extremely variable. Considerable asymmetries in the heights of the left and right posterior clinoid processes were identified; in one case, this difference was more than 1 cm (mean difference in height, 0.9 mm; range, 0–10.3 mm). The heights of the posterior clinoid processes above the sellar floor ranged from 5.8 to 14.1 mm (mean height, 9.5 mm). We were able to determine the feasibility of the pterional/orbitozygomatic, middle fossa/anterior petrosal, and presigmoid retrolabyrinthine approaches to an individual basilar bifurcation. We also estimated the amount of bone removal required and determined the operative distances via those approaches. CONCLUSION Three-dimensional computed tomographic angiography is a useful tool for assessing critical anatomic relationships and represents an adjunct to conventional angiography in the planning of individualized, precisely tailored, cranial base approaches to the vertebrobasilar system.

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Utility of Three-dimensional Computed Tomographic Angiography for Assessment of Relationships between the Vertebrobasilar System and the Cranial Base

Neurosurgery ◽

10.1227/00006123-200102000-00014 ◽

2001 ◽

Vol 48 (2) ◽

pp. 318-327 ◽

Cited By ~ 3

Author(s):

Alan T. Villavicencio ◽

Linda Gray ◽

Jean-Christophe Leveque ◽

Takanori Fukushima ◽

Sohaib Kureshi ◽

...

Keyword(s):

Three Dimensional ◽

Cranial Base ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Vertebrobasilar System ◽

Tomographic Angiography

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Three-Dimensional Computed Tomographic Angiography in Four Patients with Dissecting Aneurysms of the Vertebrobasilar System

Acta Neurochirurgica ◽

10.1007/s007010070054 ◽

2000 ◽

Vol 142 (9) ◽

pp. 995-1001 ◽

Cited By ~ 5

Author(s):

M. Nakatsuka ◽

S. Mizuno

Keyword(s):

Three Dimensional ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Vertebrobasilar System ◽

Tomographic Angiography ◽

Dissecting Aneurysms

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Imaging in Propeller Flap Surgery

Seminars in Plastic Surgery ◽

10.1055/s-0040-1715159 ◽

2020 ◽

Vol 34 (03) ◽

pp. 145-151

Author(s):

Shimpei Ono ◽

Hiroyuki Ohi ◽

Rei Ogawa

Keyword(s):

Low Cost ◽

Three Dimensional ◽

Duplex Sonography ◽

Computed Tomographic Angiography ◽

Ease Of Use ◽

Computed Tomographic ◽

Imaging Tool ◽

Preoperative Mapping ◽

Flap Design ◽

Tomographic Angiography

AbstractSince propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design intraoperatively when a reliable perforator cannot be found where expected to exist. Thus, accurate preoperative mapping of perforators is essential in the safe planning of propeller flaps. Various methods have been reported so far: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography (CDS), (3) perforator computed tomographic angiography (P-CTA), and (4) magnetic resonance angiography (MRA). To facilitate the preoperative perforator assessment, P-CTA is currently considered as the gold standard imaging tool in revealing the three-dimensional anatomical details of perforators precisely. Nevertheless, ADS remains the most widely used tool due to its low cost, faster learning, and ease of use despite an undesirable number of false-positive results. CDS can provide hemodynamic characteristics of the perforator and is a valid and safer alternative particularly in patients in whom ionizing radiation and/or contrast exposure should be limited. Although MRA is less accurate in detecting smaller perforators of caliber less than 1.0 mm and the intramuscular course of perforators at the present time, MRA is expected to improve in the future due to the recent developments in technology, making it as accurate as P-CTA. Moreover, it provides the advantage of being radiation-free with fewer contrast reactions.

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Preoperative Use of CT Angiography in Infants With Coarctation of the Aorta

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116683929 ◽

2017 ◽

Vol 8 (2) ◽

pp. 196-202 ◽

Cited By ~ 8

Author(s):

Kirsten Rose-Felker ◽

Joshua D. Robinson ◽

Carl L. Backer ◽

Cynthia K. Rigsby ◽

Osama M. Eltayeb ◽

...

Keyword(s):

Radiation Dose ◽

Surgical Approach ◽

New Technology ◽

Three Dimensional ◽

Coarctation Of The Aorta ◽

Computed Tomographic Angiography ◽

Great Vessel ◽

Z Score ◽

Computed Tomographic ◽

Tomographic Angiography

Background: Computed tomographic angiography (CTA) and echocardiography (echo) are used preoperatively in coarctation of the aorta to define arch hypoplasia and great vessel branching. We sought to determine differences in quantitative measurements, as well as surgical utility, between modalities. Methods: Infants (less than six months) with both CTA and echo prior to coarctation repair from 2004 to 2013 were included. Measurements were compared and correlated with surgical approach. Three surgeons reviewed de-identified images to predict approach and characterize utility. Computed tomographic angiography radiation dose was calculated. Results: Thirty-three patients were included. No differences existed in arch measurements between echo and CTA ( z-score: −2.59 vs −2.43; P = .47). No differences between modalities were seen for thoracotomy ( z-score: −2.48 [echo] vs −2.31 [CTA]; P = .48) or sternotomy ( z-score: −3.13 [echo] vs −3.08 [CTA]; P = .84). Computed tomographic angiography delineated great vessel branching pattern in two patients with equivocal echo findings ( P = .60). Surgeons rated CTA as far more useful than echo in understanding arch hypoplasia and great vessel branching in cases where CTA was done to resolve anatomical questions that remain after echo evaluation. Two of three surgeons were more likely to choose the surgical approach taken based on CTA (surgeon A, P = .02; surgeon B, P = .01). Radiation dose averaged 2.5 (1.6) mSv and trended down from 2.9 mSv (1.8 mSv; n = 20) to 1.6 mSv (0.5 mSv; n = 7) ( P = .06) with new technology. Conclusion: Although CTA and echo measurements of the aorta do not differ, CTA better delineates branching and surgeons strongly prefer it for three-dimensional arch anatomy. We recommend CTA for patients with anomalous arch branching patterns, diffuse or complex hypoplasia, or unusual arch morphology not fully elucidated by echo.

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