Two-color 3D-3D fusion of selective rotational cerebral angiograms: a novel approach to imaging in cerebrovascular neurosurgery

Ali Jalali, Visish M. Srinivasan, Ponraj Chinnadurai, Peter Kan, Adam Arthur, Edward A.M. Duckworth

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


BACKGROUND: Since its introduction, digital subtraction angiography has been considered the gold standard in diagnostic imaging for neurovascular disease. Modern post-processing techniques have made angiography even more informative to the cerebrovascular neurosurgeon or neurointerventionalist. Open neurosurgical procedures such as aneurysm clipping, extirpation of arteriovenous malformations, and extracranial-intracranial bypass remain important techniques in the armamentarium of a comprehensive cerebrovascular neurosurgeon. In-depth study of the anatomy of vascular pathology prior to and after surgery, often via selective cerebral angiography, is a critical component of surgical planning. However, when a vascular lesion or relevant anatomical region is perfused by two or more vascular territories, each selective angiographic imaging volume may provide an incomplete anatomical picture.

METHODS: An institutional database was searched for cases in which the syngo Inspace 3D-3D fusion software was used and assisted in diagnosis and surgical management.

RESULTS: In the six cases reviewed, the 3D-3D fusion imaging was crucial in understanding the anatomy of the vascular lesion and aided in surgical decision-making. The cases included two unique anterior communicating artery aneurysms, an arteriovenous malformation, an extracranial-intracranial bypass, and an angiographically negative subarachnoid hemorrhage.

CONCLUSIONS: This is a novel strategy of combining two independently acquired selective cerebral angiography volumes to create a more accurate representation of the vascular anatomy. Given the increasing availability of the relevant image acquisition and processing technologies, we propose this strategy as a valuable adjunct in cerebrovascular procedures.

Original languageEnglish (US)
Pages (from-to)1056-1060
Number of pages5
JournalJournal of neurointerventional surgery
Issue number10
StatePublished - Oct 1 2016
Externally publishedYes


  • Aneurysm
  • Angiography
  • Arteriovenous Malformation
  • CT Angiography
  • Subarachnoid

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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