Highlights
- •Leksell GammaPlan® with the use of contrast-enhanced CISS and CTA images is helpful for preoperative 3D evaluation of paraclinoid aneurysms.
- •Preoperative 3D evaluation of paraclinoid aneurysms within Leksell GammaPlan® provides high accuracy of their intradural localization.
- •Preoperative 3D evaluation of paraclinoid aneurysms within Leksell GammaPlan® supports decision-making on their optimal management.
Abstract
Background
Determination of the intradural unruptured paraclinoid aneurysm localization is difficult,
but critical for selection of the optimal treatment strategy.
Objective
To assess efficacy of the three-dimensional (3D) evaluation of unruptured paraclinoid
aneurysms within Leksell GammaPlan® (LGP; Elekta AB; Stockholm, Sweden) for determination
of their intradural localization.
Methods
Overall, 125 incidentally diagnosed unruptured paraclinoid aneurysms in 118 patients
(mean age, 55 years) underwent 3D evaluation of their localization within LGP using
post-contrast thin-slice constructive interference in steady state (CISS) images,
which in 41 cases were additionally co-registered and fused with the axial computed
tomography angiography (CTA) source images.
Results
According to the evaluation within LGP, paraclinoid aneurysms were considered intradural,
transitional, and extradural in 75, 25, and 25 cases respectively. Overall, 51 of
75 aneurysms deemed to be intradural, underwent microsurgical management, and intraoperative
visual inspection confirmed their intradural localization in 45 cases, whereas it
was transitional in 3, and extradural in 3. If during preoperative 3D evaluation within
LGP only post-contrast CISS images were used, prediction of the pure intradural localization
of aneurysm was correct in 88 % of cases (95 % CI: 79–97 %), and of the pure or partial
(i.e., transitional) intradural localization in 94 % of cases (95 % CI: 88–100 %),
whereas it was 100 % if co-registration and fusion of the contrast-enhanced CISS and
CTA source images was done.
Conclusion
Intradural localization of the unruptured paraclinoid aneurysms may be effectively
predicted based on their 3D evaluation within LGP using post-contrast thin-slice CISS
and CTA source images, which may help with clinical decision-making.
Keywords
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Article info
Publication history
Accepted:
December 2,
2022
Received:
August 1,
2022
Identification
Copyright
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