• Shaan M Raza, Kyriakos Papadimitriou, Dheeraj Gandhi, Martin Radvany, Alessandro Olivi, and Judy Huang.
• Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
• Neurosurgery. 2012 Dec 1;71(2 Suppl Operative):ons240-52; discussion ons252.

BackgroundPrecise intraoperative surgical localization of small distal aneurysms, arteriovenous malformations (AVMs), and cranial base dural arteriovenous fistulae may be challenging. Current neuronavigational techniques are based on imaging techniques with limited sensitivity to detect vascular lesions that are small. We introduce the technique of intraoperative computed tomography angiography (iCTA) with an intra-arterial injection for surgical navigation.ObjectiveTo determine whether iCTA integrated with a navigation platform is accurate and useful for precise localization of small vascular lesions that are challenging to treat.MethodsThis study included 8 patients: 2 with aneurysms, 3 with small cortical AVMs, and 3 with cranial base dural arteriovenous fistulae. iCTA with intra-arterial contrast injection was performed in all patients for precise localization of the small vascular lesion to facilitate craniotomy planning and microsurgical approach. All operative reports, inpatient and outpatient records, and radiographic studies available were reviewed retrospectively.Results: The iCTA was used to target 2 aneurysms, 3 small subcortical AVMs, and 3 dural arteriovenous fistulae. This technique was most helpful to localize the 3 AVMs and the distal M4 aneurysm precisely. Craniotomy planning was accurate in all instances; no complications related to the technique were noted, and all patients had uneventful postoperative recoveries.ConclusioniCTA is an effective and accurate novel technique that can enhance the safety of surgical treatment for small intra-axial vascular pathology.AbbreviationsAVM, arteriovenous malformationCTA, computed tomography angiographyDAVF, dural arteriovenous fistulaDSA, digital subtraction angiographyiCTA, intraoperative computed tomography angiographyMCA, middle cerebral arteryMSCT, multislice computed tomographyMRA, magnetic resonance angiography.

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