NEUROSURGERY Report

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BACKGROUND: In aneurysm surgery, it is mandatory to understand the microanatomy around the aneurysm, such as perforating arteries and cranial nerves.

OBJECTIVE: We used Fast Imaging Employing Steady state Acquisition (FIESTA) images of magnetic resonance imaging (MRI) preoperatively, in addition to computed tomography and digital subtraction angiography if possible, to clearly determine the microanatomy.

METHODS: Between October 2006 and June 2009, 123 patients with 140 unruptured cerebral aneurysms were treated in our institution. Eighty-two patients were assessed using FIESTA by the operators on the workstation of the MRI before surgical clipping of the aneurysms. The small vessels and cranial nerves were confirmed intraoperatively before or after obliteration of the aneurysms.

RESULTS: Sensitivities and specificities of FIESTA imaging were 100% in detecting hypothalamic artery around anterior communicating artery aneurysms, oculomotor nerve attachment to the posterior communicating artery aneurysm domes, and anterior choroidal artery adhesion to the posterior communicating artery aneurysms. This technique was also useful in predicting adhesion between aneurysm and adjacent main trunks or perforators. Although the specificity was 100%, sensitivity was 56% in detecting vessel adhesion around the middle cerebral aneurysms. This technique can provide limited information in large sized aneurysms or aneurysms located in minimal cerebrospinal fluid (CSF) space. The overall outcome of the patients was 120 excellent recoveries, 1 moderate deficit, 1 severe deficit, and 1 persistent vegetative state according to Glasgow Outcome Scale.

CONCLUSION: FIESTA can contribute to thorough preoperative evaluation of cerebral aneurysms by giving information of minute anatomical structure around the aneurysm.

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