Imaging of the Internal Carotid Artery and Adjacent Skull Base with Three-Dimensional CT Angiography for Preoperative Planning and Intraoperative Surgical Navigation

Abstract

Introduction: Three-dimensional computed tomographic angiography (3D-CTA) demonstrates the spatial relationships of the internal carotid artery (ICA) and adjacent skull base. This imaging modality may be incorporated into intraoperative surgical navigation. Methods: The charts of all patients who had undergone 3D-CTA imaging between July 2002 and June 2004 were reviewed. For 3D-CTA, 1-mm axial CT scan images were obtained with simultaneous intravenous contrast bolus on a multidetector CT scanner. The CBYON Suite version 2.6–2.8 (Med-Surgical Services, Inc., Mountain View, CA) was used to create CTA images through its volume-rendering protocols. Results: A total of 20 patients had 21 3D-CTA studies performed for diagnostic evaluation and/or preoperative planning and in 16 instances, the 3D-CTA images were used during intraoperative surgical navigation. The diagnoses included neoplasm (7 malignant and 4 benign), fibro-osseous lesion (2), fungal sphenoiditis (2), CSF leak (2), mucocele (1), and other (2). Images generated by 3D-CTA helped easily define the anatomic relationships between the ICA and skull base lesion. During intraoperative surgical navigation, the 3D-CTA provided critical information about the ICA location and adjacent skull base anatomy in the operative field. Conclusion: 3D-CTA is a useful means for assessing the ICA and its relationship to skull base lesions. Incorporation of 3D-CTA into intraoperative surgical navigation facilitates the comprehension of operative field anatomy in the ICA region. As a result, this imaging technique, especially when combined with intraoperative surgical navigation, may enhance surgical outcomes. This strategy extends the applications of minimally invasive endoscopic approaches to the skull base.