Neuronavigation for Intraoperative Localization of Cerebral Aneurysms

Localization and delineation of the extent of lesions are critical for safe management of brain tumors and vascular abnormalities. Neuronavigation systems have been developed for image-guided neurosurgery to aid accurate localization and better visualization of these lesions. Navigation has been mainly used in brain biopsy and tumor resection. There have been a few reports on its use in vascular surgery and they suggest that neuronvigation could be helpful. A 53-year-old man developed a severe sudden headache 2 days before admission. He did not have any specific medical problems. On inspection of neurological status, he was alert and his motor power was normal in all extremities. CT scan on admission showed diffuse blood in sylvian fissures and basal cisterns. Angiography revealed an aneurysmal dilatation where the posterior communicating artery arises from the right internal carotid artery (ICA). MRI scan with appropriate protocol for neuronavigation was performed and demonstrated, on Gadolinium (Gd) enhanced images, a small round hyperintense lesion in parasellar region on the right side. We prepared the navigation based on CT scan and MRI for surgery of the aneurysm. Right frontotemporal craniotomy was performed, brain retracted and arachnoid membranes were opened under the guidance of navigation-MRI. The neck was dissected and a clip was applied to the aneurysm. Neurological status of the patient was unchanged postoperatively and control CT scan was unremarkable. According to the reports and our case we suggest that MRI based neuronavigation results in accurate localization of the aneurysm, increases visualization of the lesion, decreases normal parenchymal and vascular injury and is useful for the treatment of ruptured intracranial aneurysms in special cases.