• Francesco Cardinale, Guglielmo Pero, Luca Quilici, Mariangela Piano, Paola Colombo, Alessio Moscato, Laura Castana, Giuseppe Casaceli, Dalila Fuschillo, Luciana Gennari, Marco Cenzato, Lo RussoGiorgioGClaudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Hospital, Milan, Italy., and Massimo Cossu.
• Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Hospital, Milan, Italy. Electronic address: francesco.cardinale@ospedaleniguarda.it.
• World Neurosurg. 2015 Aug 1; 84 (2): 358367358-67.

ObjectiveCerebrovascular imaging is critical for safe and accurate planning of Stereo-ElectroEncephaloGraphy (SEEG) electrode trajectory. We developed a new technique for Cone Beam Computed Tomography (CBCT) Three-Dimensional Digital Subtraction Angiography (3D DSA).MethodsThe workflow core is the acquisition of computed tomography datasets without (bone mask) and with selective injection of contrast medium in the main brain-feeding arteries, followed by dataset registration and subtraction. The images were acquired with the O-armTM 1000 System (Medtronic). Images were postprocessed with FSL software package. We retrospectively analyzed 191 3D DSA procedures and qualitatively analyzed the quality of each 3D DSA dataset.ResultsThe quality of 3D DSA was good in 150 procedures, sufficient in 37, and poor in 4. 3D rendering of the vascular tree was helpful for both SEEG implantation and resective surgery planning. Angiography complications occurred in only one procedure that was aborted due to a major allergic reaction to contrast medium. No other complications directly related to 3D DSA occurred. Minor intracerebral hemorrhage occurred in 2/191 patients after SEEG implantation, with no permanent sequelae.ConclusionsCBCT 3D DSA is a safe diagnostic procedure for SEEG electrode trajectory planning and for 3D reconstructions of the vascular tree in multimodal scenes for resections. The high fidelity and geometric accuracy contribute to the safety of electrode implantation.Copyright © 2015 Elsevier Inc. All rights reserved.

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