Angiographic angular adjustment: matching angiographic views and surgical findings to estimate the actual arterial anatomy in surgery for intracranial aneurysm - technical note

Abstract

AIM: To describe a simple technique of angular adjustment of cerebral angiographic views that makes them similar to the surgical field under the operation microscope. MATERIAL and METHODS: The technique of angular adjustment consists of three steps: 1. Upside-down 180-degree rotation of the standard angiographic anterior-posterior view, 2. Adjustment of the course of the angiographic internal carotid artery according to the actual internal carotid artery seen in surgery under the operating microscope, and 3. A final and more accurate angular adjustment by rotating the angiographic view in its final position, as soon as parent arteries to aneurysm, such as the internal carotid, anterior cerebral, and middle cerebral arteries, are seen in surgery. RESULTS: The use of the technique provided a fair approximation of a rotated angiographic view and the actual surgical point of view. The technique is simple, and no sophisticated technology is needed. CONCLUSION: The angiographic data adjusted angularly to the surgeon’s point of view at surgery, very similar to the actual directions of arteries and the fundus of the aneurysm, is likely helpful to the microneurosurgeon for safely exploring aneurysms in conjunction with proximal and distal arteries. KEYWORDS: Cerebral angiography, Aneurysm, Anterior communicating artery, Middle cerebral artery, Internal cerebral artery