Article Figures & Data
Figures
- Fig 1.
Anteroposterior DSA images demonstrate left vertebral artery injections in the early (A) and late (B) arterial phases, identifying arteriovenous shunting and early venous drainage into a hypertrophied superior cerebellar hemispheric vein (arrow) with tentorial venous outflow, but both observers were unable to appreciate an occult micronidus. Although arterial feeders are suggested to project into this region on DSA from the right anterior cerebellar artery and SCA (A, arrowheads), the SCA feeder is better appreciated on IA-CBCTA multiplanar axial reconstructions (C, arrowhead). Moreover, both observers identified a <5-mm micronidus under the lateral cerebellar surface and adjacent to the craniectomy site (C, arrow) with adjunctive IA-CBCTA reconstructions, consistent with an mAVM. IA-CBCTA coronal reconstruction (D) shows the nidal outflow to the early draining superior cerebellar hemispheric vein (arrow).
- Fig 2.
Axial MR imaging MPRAGE postgadolinium (A) image demonstrates a right parasagittal frontoparietal intraparenchymal hemorrhage with a contrast-enhancing pseudoaneurysm (white arrow), consistent with the rupture site. Lateral oblique DSA images in the early arterial phase confirm a pericallosal anterior cerebral artery aneurysm/pseudoaneurysm (B, black arrow), with a subtle early draining vein in the capillary phase (C, black arrowheads), but no distinct vascular nidus was identified by either observer. Only IA-CBCTA multiplanar reconstructions clearly delineate a <5-mm micronidus on axial and sagittal reconstructions (D and E, white arrows). Coronal multiplanar reconstructions also assist in identification of the small arterial feeder from the pericallosal-splenial artery branch (F, white arrowhead) and single draining vein (G, double asterisks) directly associated with the micronidus and flow-induced pseudoaneurysm.
- Fig 3.
Lateral DSA (A) and coronal IA-CBCTA reconstruction (B) images both demonstrate a small <1-cm micronidus (arrows), supplied by tortuous parietal branches of the pericallosal anterior cerebral artery and inferior division of the MCA (arrowheads), with early venous drainage into bifurcating cortical veins (double asterisks). Although both observers did not report the improved diagnostic value of IA-CBCTA in this case, both neurosurgeons reported increased confidence in treatment planning, and IA-CBCTA was incorporated into the neuronavigation system for microsurgical resection. 3D IA-CBCTA and MR imaging datasets were merged with sagittal overlay (C) delineating the micronidus (arrow) and draining cortical vein (double asterisks) complex in relation to the adjacent hemorrhage. Both datasets were imported into the intraoperative neuronavigation system (D, BrainLAB), allowing anatomic localization of the micronidus within a specific sulcus guiding the surgical approach as well as the presumed deep nidal rupture site abutting the hematoma (black arrow).
Tables
Observer 1 Observer 2 Arterial Feeder Nidus Venous Drainage Overall Relative CBCTA Diagnostic Valuea Arterial Feeder Nidus Venous Drainage Overall Relative CBCTA Diagnostic Valuea DSA CBCTA DSA CBCTA DSA CBCTA DSA CBCTA DSA CBCTA DSA CBCTA DSA CBCTA DSA CBCTA 1 1 2 0 2 2 2 3 6 3 0 2 0 2 2 2 2 6 4 2 0 2 1 2 2 2 2 6 4 0 2 1 2 2 2 3 6 3 3 1 2 1 2 2 2 4 6 2 0 2 1 2 2 2 3 6 3 4 1 2 0 2 1 2 2 6 4 1 2 0 2 1 2 2 6 4 5 1 2 1 2 2 2 4 6 2 1 2 0 2 2 2 3 6 3 6 2 2 0 2 2 2 4 6 2 2 2 1 2 2 2 5 6 1 7 1 2 1 2 2 2 4 6 2 2 2 1 2 2 2 5 6 1 8 2 2 2 2 0 1 4 5 1 1 2 2 2 0 1 3 5 2 9 2 2 2 2 2 2 6 6 0 2 1 2 2 2 1 6 4 −2 10 2 2 0 2 2 2 4 6 2 1 2 1 2 2 2 4 6 2 P .02 .009 .157 .007 .03 .009 .564 .016 τ coefficient = 0.66, P = .018.
Patient Neurosurgeon 1 Relative CBCTA Treatment Value Neurosurgeon 2 Relative CBCTA Treatment Value DSA CBCTA DSA CBCTA 1 Not sufficient Operation 2 Not sufficient Operation 2 2 Radiosurgery Radiosurgery 1 Radiosurgery Radiosurgery 1 3 Radiosurgery Radiosurgery 1 Radiosurgery Radiosurgery 0 4 Operation Operation 1 Operation Operation 1 5 Operation Operation 1 Operation Operation 1 6 Radiosurgery Radiosurgery 1 Radiosurgery Radiosurgery 1 7 Operation Operation 1 Operation Operation 1 8 Radiosurgery Radiosurgery 1 Radiosurgery Radiosurgery 1 9 Operation Operation 1 Operation Operation 1 10 Operation Operation 1 Operation Operation 1 ↵a τ coefficient = 0.73, P = .025.
Jump to section
Related Articles
Cited By...
- No citing articles found.