• Kenji Fukuda, Toshio Higashi, Masakazu Okawa, Mitsutoshi Iwaasa, Hiroshi Abe, and Tooru Inoue.
• Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan.
• World Neurosurg. 2016 Jan 1; 85: 353-8.

ObjectiveThe authors introduce a new fusion technique using 2 three-dimensional digital subtraction angiography images acquired by a flat-panel detector angiographic system to understand the detailed angioarchitecture of complex cerebral and spinal vascular malformations.MethodsEleven consecutive cases of arteriovenous fistula or arteriovenous malformation with lesions that involved 2 major vessels (i.e., internal carotid arteries, external carotid arteries, vertebral arteries, or spinal arteries) were included. Three-dimensional rotational angiography was performed in each affected vessel after conventional cerebral or spinal angiography. Subsequently, the 2 three-dimensional digital subtraction angiography images were fused.ResultsThe fused images provided the accurate three-dimensional angioarchitecture of complex vascular malformations clearly with high spatial resolution. In particular, the relationship between the nidus/fistulous point, the feeding arteries from each major vessel, and the draining veins could be easily delineated from different directions and multiple angles. Surgical or endovascular treatment was performed in all cases based on the information from these fused three-dimensional images.ConclusionsA fusion technique using two three-dimensional digital subtraction angiography is beneficial for preoperative planning and successful treatment in cases of complex cerebral and spinal vascular malformations.Copyright © 2016 Elsevier Inc. All rights reserved.

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